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Benarous X, Walesa S, Guilé JM, Cravero C, Consoli A, Cohen D, Young H, Labelle R, Lahaye H. A systematic review of the psychometric properties of tools for measuring depression in youths with intellectual disability. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02405-x. [PMID: 38509427 DOI: 10.1007/s00787-024-02405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
While youths with intellectual disability (ID) have increased vulnerability for depressive disorders, cognitive problems and combined functional barriers make them less prone to receive adequate treatments. A systematic review of the literature was conducted (PROSPERO Registration number: CRD42022347703) based on several databases from 1980 to 2022 to examine the quality of tools for measuring depression in children and adolescents with ID. The COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist was used to assess several psychometric domains. Twelve studies evaluated the properties of six tools for measuring depression in youths with ID. The Center for Epidemiologic Studies Depression Scale-Intellectual Disability (CESD-ID) was the only scale with at least five domains of psychometric properties assessed to have strong or moderate evidence. Based on the reviewed findings, tools specifically developed for populations with developmental disabilities should be considered first in order to screen depression in youths with ID. Much work is required to confirm their validity in clinical samples with patients with a complex form of developmental disabilities. As a complement to self- and caregivers-report questionnaires, clinician rating scales were considered useful to catch the full picture of depression in youths with ID, in particular associated behavioral expressions. Their validity received little scrutiny and certainly deserve more attention to improve care practice of youths with ID.
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Affiliation(s)
- Xavier Benarous
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France.
| | | | | | - Cora Cravero
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - Angèle Consoli
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - David Cohen
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | | | - Real Labelle
- Université du Québec À Montréal, Montréal, Canada
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2
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Smeets G, Volkers K, Scherder E, Moonen X. An Individual Music Intervention for Adults With Intellectual Disabilities and Challenging Behavior: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52497. [PMID: 38324357 PMCID: PMC10882479 DOI: 10.2196/52497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Individuals with intellectual disabilities (ID) are more likely to have problems with executive functioning (EF) and challenging behavior (CB), which are negatively linked to well-being. Among clinical populations, music interventions have been shown to improve various outcome measures, such as CB and EF. Until now, no randomized controlled trials (RCTs) have been conducted to examine the effectiveness of an individual music intervention for adults with ID and CB. OBJECTIVE The study aims to identify the effect and feasibility of an individual music intervention compared with care-as-usual for people with ID and CB. METHODS In this study, a 2-group RCT with a pretest, posttest, and follow-up assessment after 8 weeks is presented. Participants of the music intervention condition will receive 16 individual music sessions within 8 to 10 weeks. The music intervention will be guided by a manual for music workers, in which every session will have a different focus (introduction, emotions, different EF, and end performance). Participants receiving care as usual will function as a control group. After the research is finished, they will be offered a budget, which they can spend on musical activities or musical instruments as they wish. Assessments will include caregiver rating scales and self-report questionnaires and tests, which will assess outcome measures of CB, well-being, depression, anxiety, self-esteem, and 4 domains of EF. A process evaluation will be conducted after the completion of the study, which entails the analysis of data on multiple aspects of the intervention and the study overall. RESULTS Enrollment commenced in July 2021, and data collection ended in May 2023. A total of 97 participants were recruited, with 44 participants allocated to the intervention group and 53 allocated to the control group. Data will be analyzed after this protocol has been accepted for publication. CONCLUSIONS Because there are currently no published RCTs of an individual music intervention for adults with ID and CB, this study will provide insight into the effectiveness and experiences of an individual music intervention for this target group. TRIAL REGISTRATION International Clinical Trials Registry Platform NL8482; http://tinyurl.com/4565s5pd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52497.
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Affiliation(s)
| | - Karin Volkers
- Philadelphia Care Foundation, Amersfoort, Netherlands
| | - Erik Scherder
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands
| | - Xavier Moonen
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
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Aghabozorgi K, van der Jagt A, Bell S, Brown C. Assessing the impact of blue and green spaces on mental health of disabled children: A scoping review. Health Place 2023; 84:103141. [PMID: 37951182 DOI: 10.1016/j.healthplace.2023.103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
During recent decades, there has been a growing consideration of the role of blue and green spaces on mental health of children, but there is insufficient attention in the literature to the mental health of children with disabilities. This paper presents an overview of the evidence on how blue and green spaces affect the mental health of children with various disabilities. A database search found twenty studies eligible for the review, after several consecutive screening stages. Most studies used a cross-sectional design and were carried out in Europe. The results consistently indicate that blue and green space can reduce emotional, behavioral, and social problems in disabled children. A protective association was found between the level of blue or greenness and depressive and anxiety symptoms. Moreover, in most of the studies there were no significant changes in the result after adjusting for socioeconomic confounders. Generally, there is an identified need for more short-term exposure studies in this area, focusing on the impact of landscape design elements on mental health of disabled children. The findings of this scoping review call on urban planners, health care workers and decision makers to consider appropriate measures and interventions providing more blue and green space exposure to disabled children.
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Affiliation(s)
- Koorosh Aghabozorgi
- School of Energy, Geoscience, Infrastructure and Society, Heriot Watt University, Edinburgh, UK.
| | - Alexander van der Jagt
- School of Energy, Geoscience, Infrastructure and Society, Heriot Watt University, Edinburgh, UK
| | - Simon Bell
- Chair of landscape architecture, Estonian University of Life Sciences, Kreutzwaldi 56/1, Tartu, 51009, Estonia
| | - Caroline Brown
- School of Energy, Geoscience, Infrastructure and Society, Heriot Watt University, Edinburgh, UK
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Baksh RA, Sheehan R, Hassiotis A, Smith J, Strydom A. Identifying individuals with intellectual disability who access mental health support and are at high risk for adverse clinical outcomes: cohort study. BJPsych Open 2023; 9:e183. [PMID: 37813547 PMCID: PMC10594232 DOI: 10.1192/bjo.2023.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND People with intellectual disability often experience aggressive challenging behaviour and mental health issues. It can be difficult to identify those who are at higher risk of adverse clinical outcomes when in clinical care. AIMS To characterise potential subgroups in adults with intellectual disability referred to mental health services in those presenting with aggressive behaviour or common mental disorders (CMDs). METHOD There were 836 adults (≥18 years) with intellectual disability and a record of aggressive challenging behaviour, and 205 patients with intellectual disability and CMDs, who were seen in specialist mental health services over a 5-year period. Cluster analysis was used to define patient characteristics associated with clinical outcome. RESULTS Distinct patient groups with differentiated profiles were observed in people with intellectual disability displaying aggressive challenging behaviour, and in those presenting with CMDs. Characteristics of the aggressive behaviour group who experienced adverse outcomes included being <30 years old, being male, more mentions of aggression and agitation in their clinical record, a diagnosis of pervasive developmental disorder and prescription of psychotropic medication. Characteristics of the CMD cluster that experienced adverse clinical outcomes were being older, being a White male, having a mild intellectual disability and physical health concerns. CONCLUSIONS People with intellectual disability who experience adverse clinical outcomes can be identified with a cluster analysis approach of common features, but differ by clinical presentation. This could be used not only to stratify this clinically heterogeneous population in terms of response to interventions, but also improve precision in the development of tailored interventions.
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Affiliation(s)
- R. Asaad Baksh
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and The LonDowns Consortium, London, UK
| | - Rory Sheehan
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, UK; and Camden Learning Disabilities Service, London, UK
| | - James Smith
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Strydom
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; The LonDowns Consortium, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
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5
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James SN, Nicholas JM, Lu K, Keshavan A, Lane CA, Parker T, Buchanan SM, Keuss SE, Murray-Smith H, Wong A, Cash DM, Malone IB, Barnes J, Sudre CH, Coath W, Modat M, Ourselin S, Crutch SJ, Kuh D, Fox NC, Schott JM, Richards M. Adulthood cognitive trajectories over 26 years and brain health at 70 years of age: findings from the 1946 British Birth Cohort. Neurobiol Aging 2023; 122:22-32. [PMID: 36470133 PMCID: PMC10564626 DOI: 10.1016/j.neurobiolaging.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Few studies can address how adulthood cognitive trajectories relate to brain health in 70-year-olds. Participants (n = 468, 49% female) from the 1946 British birth cohort underwent 18F-Florbetapir PET/MRI. Cognitive function was measured in childhood (age 8 years) and across adulthood (ages 43, 53, 60-64 and 69 years) and was examined in relation to brain health markers of β-amyloid (Aβ) status, whole brain and hippocampal volume, and white matter hyperintensity volume (WMHV). Taking into account key contributors of adult cognitive decline including childhood cognition, those with greater Aβ and WMHV at age 70 years had greater decline in word-list learning memory in the preceding 26 years, particularly after age 60. In contrast, those with smaller whole brain and hippocampal volume at age 70 years had greater decline in processing search speed, subtly manifest from age 50 years. Subtle changes in memory and processing speed spanning 26 years of adulthood were associated with markers of brain health at 70 years of age, consistent with detectable prodromal cognitive effects in early older age.
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Affiliation(s)
- Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Medicine, Division of Brain Sciences, Imperial College London
| | - Sarah M Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - William Coath
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marc Modat
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Jonathan M Schott
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Branford D, Shankar R. Antidepressant prescribing for adult people with an intellectual disability living in England. Br J Psychiatry 2022; 221:488-493. [PMID: 35249557 DOI: 10.1192/bjp.2022.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The prescribing of psychotropic medications for people with an intellectual disability has changed. In many locations across England, antidepressants have become the most widely prescribed psychotropic. In the context of the current NHS England STOMP programme to reduce inappropriate psychotropic prescribing for people with intellectual disability, there is an urgent need to understand whether this change reflects evidence-based use of the medications involved. There has been little analysis into the benefits or problems associated with the change and whether it is of concern. This paper offers a variety of possible explanations and opportunities to improve clinical practice and policy.
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Affiliation(s)
- David Branford
- Cornwall Intellectual Disability Equitable Research, University of Plymouth Peninsula Medical School, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth Peninsula Medical School, UK; and Services for People with Adult Learning Disabilities, Cornwall Partnership NHS Foundation Trust, UK
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7
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Brown HK, Tint A, Heifetz M, Chacra MA, Bluestein D, Vigod S, Lunsky Y. Barriers and requirements for parenting supports and mental health care among mothers with intellectual disabilities: Health and social service-provider perspectives. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104237. [PMID: 35487050 DOI: 10.1016/j.ridd.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mothers with intellectual disability (ID) experience high rates of mental illness, but these needs are not adequately addressed. AIMS We examined health and social service-provider perceptions of barriers to parenting and mental health care among mothers with ID and strategies for building good practice capacity. METHODS AND PROCEDURES In this qualitative study in Ontario, Canada, we interviewed 13 service-providers working with mothers with ID about their experiences supporting parenting and mental health in mothers with ID, including barriers to services and strategies for building good practice capacity. Data were analyzed via inductive, semantic-level thematic analysis. OUTCOMES AND RESULTS Perceived barriers to care provision were the vulnerable social context of women with ID, distrust of "the system" by women with ID, and siloed services. Increased training of service-providers, making accommodations in existing services, and building a community of support for women with ID were offered as strategies for good practice capacity. CONCLUSIONS AND IMPLICATIONS Efforts to improve mental health among mothers with ID should focus on improving service-provider capacity and accommodations in existing services, and enhancing coordination of care. WHAT THIS PAPER ADDS?: Mothers with intellectual disability (ID) experience high rates of mental illness, but supports for mothers with ID typically focus on parenting skills, and women's mental health care services do not consider the unique needs of those with ID. Health and social service-providers have reported inadequate training, fragmented services, high caseloads, and lack of practical supports as barriers to providing quality care to mothers with ID. However, no studies have examined service-providers' perceptions of needs related specifically to parenting and mental health among mothers with ID. This study provides new information on barriers to parenting and mental health care among mothers with ID and strategies for good practice capacity, from the perspectives of service-providers. Perceived barriers to care provision include social determinants of health, a distrust of "the system" by women with ID, and siloed services. Providers recommended that providing better training, including accommodations in existing services, and building a community of support could be beneficial to improving practice capacity in the context of mental health care and parenting supports. These factors need to be addressed to improve mental health among mothers with ID.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada; Dalla Lana School of Public Health, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marina Heifetz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Richards M, James SN, Lu K, Livingston G, Schott JM, Lane CA, Barnes J, Parker TD, Sudre CH, Cash DM, Coath W, Fox N, Davis DHJ. Straight and Divergent Pathways to Cognitive State: Seven Decades of Follow-Up in the British 1946 Birth Cohort. J Alzheimers Dis 2022; 89:659-667. [PMID: 35964185 DOI: 10.3233/jad-220296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Using the British 1946 birth cohort we previously estimated life course paths to the Addenbrooke's Cognitive Examination (ACE-III). OBJECTIVE We now compared those whose ACE-III scores were expected, worse and better than predicted from the path model on a range of independent variables including clinical ratings of cognitive impairment and neuroimaging measures. METHODS Predicted ACE-III scores were categorized into three groups: those with Expected (between -1.5 and 1.5 standard deviation; SD); Worse (&lt; -1.5 SD); and Better (&gt;1.5 SD) scores. Differences in the independent variables were then tested between these three groups. RESULTS Compared with the Expected group, those in the Worse group showed independent evidence of progressive cognitive impairment: faster memory decline, more self-reported memory difficulties, more functional difficulties, greater likelihood of being independently rated by experienced specialist clinicians as having a progressive cognitive impairment, and a cortical thinning pattern suggestive of preclinical Alzheimer's disease. Those in the Better group showed slower verbal memory decline and absence of independently rated progressive cognitive impairment compared to the Expected group, but no differences in any of the other independent variables including the neuroimaging variables. CONCLUSION The residual approach shows that life course features can map directly to clinical diagnoses. One future challenge is to translate this into a readily usable algorithm to identify high-risk individuals in preclinical state, when preventive strategies and therapeutic interventions may be most effective.
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Affiliation(s)
- Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Sarah N James
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Kirsty Lu
- Dementia Research Centre, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | | | | | | | - Thomas D Parker
- Dementia Research Centre, University College London, London, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.,Dementia Research Centre, University College London, London, UK.,Centre for Medical Image Computing, University College London, London, UK.,School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - David M Cash
- Dementia Research Centre, University College London, London, UK
| | - William Coath
- Dementia Research Centre, University College London, London, UK
| | - Nicholas Fox
- Dementia Research Centre, University College London, London, UK
| | - Daniel H J Davis
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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9
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Ali A, McKenzie E, Hassiotis A, Priebe S, Lloyd‐Evans B, Jones R, Panca M, Omar R, Finning S, Moore S, Roe C, King M. A pilot randomised controlled trial of befriending by volunteers in people with intellectual disability and depressive symptoms. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:1010-1019. [PMID: 34570405 PMCID: PMC9291894 DOI: 10.1111/jir.12886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND People with intellectual disability (ID) are more likely to experience chronic depression compared with the general population, which may be compounded by loneliness and lower levels of social support. Befriending aims to provide social support and promote engagement in community activities. No randomised controlled trials have examined whether befriending improves symptoms of depression and social outcomes in people with ID. The aim of this pilot trial was to assess the feasibility and acceptability of a future larger trial of one-to-one befriending by volunteers in people with ID and depressive symptoms. METHODS Participants were adults with mild or moderate ID with a score of 5 or more on the Glasgow Depression Scale for People with Learning Disabilities (GDS-LD). They were randomised to the intervention arm (matched to a volunteer befriender for 6 months) or the control arm (usual care). Volunteers received training and supervision provided by two community befriending schemes. The main outcomes were feasibility of recruitment (minimum target n = 35), retention rate of participants, adherence (minimum 10 meetings), acceptability of the intervention, changes in depressive symptoms (assessed at baseline and 6 months) and feasibility of collecting data for a health economic analysis. RESULTS Recruitment was challenging, and only 16 participants with ID and 10 volunteers were recruited. Six participants were matched with a volunteer and no participants dropped out (except for two volunteers). Four participants completed 10 meetings (mean 11.8). Befriending was thought to be acceptable, but modifications were suggested. An exploratory analysis suggested that GDS-LD score was lower in the intervention group compared with the control group after adjusting for baseline scores, but not significant (adjusted mean difference: -4.0; 95% confidence interval: -11.2 to 3.2). CONCLUSIONS A large trial would not be feasible based on the recruitment strategies employed in this study. A further feasibility study addressing these challenges or the use of other study designs should be considered.
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Affiliation(s)
- A. Ali
- Epidemiology and Applied Clinical Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | - E. McKenzie
- Research and Development OfficeGoodmayes Hospital, North East London NHS Foundation TrustLondonUK
| | - A. Hassiotis
- Epidemiology and Applied Clinical Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | - S. Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services DevelopmentQueen Mary University of LondonLondonUK
| | - B. Lloyd‐Evans
- Epidemiology and Applied Clinical Research Department, Division of PsychiatryUniversity College LondonLondonUK
| | - R. Jones
- Epidemiology and Applied Clinical Research Department, Division of PsychiatryUniversity College LondonLondonUK
- Priment Clinical Trials UnitUniversity College LondonLondonUK
| | - M. Panca
- Priment Clinical Trials UnitUniversity College LondonLondonUK
| | - R. Omar
- Department of Statistical ScienceUniversity College LondonLondonUK
| | - S. Finning
- Outward HousingOutward, Newlon HouseLondonUK
| | - S. Moore
- The Befriending SchemeSudburySuffolkUK
| | - C. Roe
- The Befriending SchemeSudburySuffolkUK
| | - M. King
- Epidemiology and Applied Clinical Research Department, Division of PsychiatryUniversity College LondonLondonUK
- Priment Clinical Trials UnitUniversity College LondonLondonUK
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10
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Ali A, Mckenzie E, Rasoul Z, Hassiotis A, Priebe S, Lloyd-Evans B, Jones R, Panca M, Omar R, Finning S, Moore S, Roe C, King M. One-to-one volunteer befriending to reduce symptoms of depression in people with intellectual disability: a feasibility RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Little is known about the effectiveness of befriending for people with intellectual disability and whether or not befriending improves depressive symptoms and social outcomes.
Objective
This pilot trial aimed to assess the feasibility and acceptability of conducting a future full-scale randomised controlled trial of one-to-one befriending for people with intellectual disability who had depressive symptoms.
Design
This was a parallel-group, two-armed randomised controlled trial incorporating an exploratory economic analysis and a mixed-methods process evaluation. Outcome assessments were conducted at baseline and at 6 months post randomisation by a research assistant who was blind to allocation. We aimed to approach 50 participants, with a view to recruiting 40.
Setting
Participants with intellectual disability were recruited from one NHS trust and from referrals to two community befriending services. The intervention was delivered by community befriending services.
Participants
Adults with mild or moderate intellectual disability with a score on the Glasgow Depression Scale for people with a Learning Disability of ≥ 5 were included. Those attending a day service/college for ≥ 3 days a week were excluded. Volunteers were aged ≥ 18 years and had no history of prior convictions.
Intervention
Participants in the intervention group were matched with a volunteer befriender and were expected to meet once per week for 1 hour, over 6 months. Volunteers recorded activities in a logbook. Volunteers received training and regular supervision. Both groups received usual care and a resource booklet of local activities.
Main outcome measures
The feasibility outcomes and progression criteria were recruitment of at least 70% of participants approached; matching of at least 70% of participants in the intervention group to a volunteer; a dropout rate of < 30% of participants and volunteers; adherence to the intervention (10 meetings between pairs); acceptability of the intervention; and feasibility of collecting data on costs and resource use for an economic evaluation. Changes in depressive symptoms (primary clinical outcome: Glasgow Depression Scale) and self-esteem, quality of life, social participation, social support, health-related quality of life and service use were recorded at 6 months. Outcomes in volunteers were also assessed.
Results
We recruited only 16 participants with intellectual disability (40% of target) and 10 volunteers. Six of the eight (75%) participants in the intervention group were matched with a befriender and there was good adherence (mean number of meetings attended 11.8; range 1–21 meetings). Going to a cafe/restaurant and having a conversation were the most frequent activities. All participants were retained at follow-up, but two volunteers dropped out. Trial procedures and the intervention might be acceptable, but modifications were suggested. Data on costs and resource use were obtained, but there were discrepancies in the health-related quality-of-life data.
Limitations
Delays to the study prevented the use of alternative recruitment strategies and the planned 12-month follow-up could not be completed.
Conclusions
Recruitment was not feasible, but other feasibility outcomes were more positive.
Future work
Evaluating befriending for people with intellectual disability could be explored through alternative study designs, such as observational studies.
Trial registration
Current Controlled Trials ISRCTN63779614.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Afia Ali
- Division of Psychiatry, University College London, London, UK
| | - Emma Mckenzie
- Research and Development Office, Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Zara Rasoul
- Division of Psychiatry, University College London, London, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | | | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Monica Panca
- Priment Clinical Trials Unit, University College London, London, UK
| | - Rumana Omar
- UK Department of Statistical Science, University College London, London, UK
| | | | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
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Ali A, Mckenzie E, Hassiotis A, Priebe S, Lloyd-Evans B, Omar R, Jones R, Panca M, Fernandez V, Finning S, Moore S, O'Connor D, Roe C, King M. One-to-one befriending for people with intellectual disability and symptoms of depression: protocol for a pilot randomised controlled trial. BMJ Open 2020; 10:e033989. [PMID: 32565450 PMCID: PMC7311030 DOI: 10.1136/bmjopen-2019-033989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION People with intellectual disability (ID) are more likely to experience loneliness and have smaller social networks, which increases vulnerability to depression. Befriending may reduce depressive symptoms in other populations, but randomised controlled trials (RCTs) have not been carried out in this population. This pilot study aims to assess the acceptability and feasibility of carrying out a full RCT of one-to-one befriending by volunteers for people with ID, compared with an active control group. METHODS AND ANALYSIS The trial aims to recruit 40 participants with ID. Participants in the intervention arm will receive weekly visits from a volunteer over 6 months. Community befriending schemes will recruit, train, supervise volunteers and match them to individuals with ID. Both groups will receive a booklet about local activities and have access to usual care. Health and social outcomes will be measured at the end of the intervention and 6 months' follow-up. The following outcomes will be assessed: (1) recruitment and retention of individuals with ID and volunteers in the trial, (2) adverse events related to the intervention, (3) the acceptability of the intervention, (4) whether the intervention is delivered as intended, (5) changes in health and social outcomes and (6) the feasibility of carrying out a cost-effectiveness analysis in a full trial. Qualitative data from participants, volunteers, staff and carers will identify barriers and facilitators of a future full trial. ETHICS AND DISSEMINATION The study has been approved by the London City and East Research Ethics Committee (reference 18/LO/2188). The findings will be presented at conferences and published in a peer-reviewed journal and in the National Institute of Health Research journals library. A public engagement seminar will be held at the end of the study aimed at key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN63779614.
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Affiliation(s)
- Afia Ali
- Division of Psychiatry, University College London, London, UK
| | - Emma Mckenzie
- Research and Development, North East London NHS Foundation Trust Goodmayes Hospital, Ilford, Essex, UK
| | | | - Stefan Priebe
- Unit of Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, University of London, London, UK
| | | | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, UK
| | - Monica Panca
- Primary Care and Population Health, University College London, London, UK
| | | | - Sally Finning
- Hackney Volunteer and Befriending Scheme, Outward, London, UK
| | | | | | | | - Michael King
- Division of Psychiatry, University College London, London, UK
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Gormez A, Kurtulmus A, Ince Z, Torun P, Uysal O, Cıtak S. Psychiatric symptoms, challenging behaviour and utilization of psychiatric services among adults with intellectual disabilities in Turkey. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1038-1048. [PMID: 32207206 DOI: 10.1111/jar.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of and the factors associated with psychiatric symptoms (PS) and challenging behaviour (CB) in adults with intellectual disabilities, and the utilization of psychiatric services in Turkey. METHOD Psychiatric Assessment Schedule for Adults with Developmental Disorders Checklist-Revised was used for PS and a structured form for other variables in 771 participants. RESULTS Of the participants, 50.1% had PS and 36.4% presented with CB. Multivariate analysis revealed that a higher level of needs, better verbal ability, residential living, incontinence and CB, and lifetime suicidal ideation/attempt were independently associated with PS. For CB, it emerged as male carer, PS, lifetime suicidal attempt/ideation, lower level of verbal ability and autism spectrum disorder. Barriers were experienced by 64.7% of participants within the previous year. CONCLUSIONS Psychiatric symptoms and CB seem to be problems for a significant proportion of adults with intellectual disabilities in Turkey, and there are certain barriers to psychiatric services.
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Affiliation(s)
- Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Kurtulmus
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Ince
- Bagcilar Basak Special Education and Rehabilitation Centre, Istanbul, Turkey
| | - Perihan Torun
- Department of Public Health, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Uysal
- Department of Statistics, Bezmialem Vakif University, Istanbul, Turkey
| | - Serhat Cıtak
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
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Heifetz M, Brown HK, Chacra MA, Tint A, Vigod S, Bluestein D, Lunsky Y. Mental health challenges and resilience among mothers with intellectual and developmental disabilities. Disabil Health J 2019; 12:602-607. [PMID: 31235446 DOI: 10.1016/j.dhjo.2019.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mothers with intellectual and developmental disabilities (IDD) frequently experience mental health problems. Yet, they are excluded from broader women's mental health efforts, and few services exist to support their unique mental health needs. OBJECTIVES Our objective was to identify key risk, protective, and resilience factors that affect mental health among mothers with IDD. METHODS We interviewed mothers with IDD on: (1) a quantitative measure to assess demographics and depressive symptoms and (2) qualitative focus groups on parenting and mental health (analyzed through thematic analysis). There were three focus groups, for a total sample of 12 mothers with IDD. RESULTS The 12 women in the sample had a total of 28 children, with a mean age of 11.3 years (SD = 9.9). The mean depressive symptom score in the sample was 13.8 (SD = 5.5), with 7 women scoring above the cut-off for clinically significant symptoms. Nine thematic categories were identified, organized into risks, protective factors, and resilience factors. Risks were parenting stress, life stressors, feelings of powerlessness with the child welfare system, and feeling judged. Protective factors were formal and informal supports. Resilience factors were motherhood enjoyment, having a good family life, and wishing to be independent. CONCLUSIONS Efforts to improve mental health among mothers with IDD should minimize risks that undermine adaptive capabilities and promote resilience to restore efficacy of protective systems. Better training of service-providers working with individuals with IDD, using strength-based approaches and developing alternative, autonomy-building sources of support in the form of peer support groups is recommended.
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Affiliation(s)
- Marina Heifetz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Megan Abou Chacra
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Surrey Place Centre, Toronto, Ontario, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Jahoda A, Hastings R, Hatton C, Cooper SA, McMeekin N, Dagnan D, Appleton K, Scott K, Fulton L, Jones R, McConnachie A, Zhang R, Knight R, Knowles D, Williams C, Briggs A, Melville C. Behavioural activation versus guided self-help for depression in adults with learning disabilities: the BeatIt RCT. Health Technol Assess 2019; 22:1-130. [PMID: 30265239 DOI: 10.3310/hta22530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points) and BeatIt (11.91 points) groups at the 12-month primary outcome point. However, both groups improved during the trial. Other psychological and QoL outcomes followed a similar pattern. There were no treatment group differences, but there was improvement in both groups. There was no economic evidence suggesting that BeatIt may be more cost-effective than StepUp. However, treatment costs for both groups were approximately only 4-6.5% of the total support costs. Results of the qualitative research with participants, supporters and therapists were in concert with the quantitative findings. Both treatments were perceived as active interventions and were valued in terms of their structure, content and perceived impact. LIMITATIONS A significant limitation was the absence of a treatment-as-usual (TAU) comparison. CONCLUSIONS Primary and secondary outcomes, economic data and qualitative results all clearly demonstrate that there was no evidence for BeatIt being more effective than StepUp. FUTURE WORK Comparisons against TAU are required to determine whether or not these interventions had any effect. TRIAL REGISTRATION Current Controlled Trials ISRCTN09753005. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 53. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Chris Hatton
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.,Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Kim Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katie Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Jones
- School of Psychology, Bangor University, Bangor, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel Zhang
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rosie Knight
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Dawn Knowles
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Andy Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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So HC, Wong YH. Implications of de novo mutations in guiding drug discovery: A study of four neuropsychiatric disorders. J Psychiatr Res 2019; 110:83-92. [PMID: 30597425 DOI: 10.1016/j.jpsychires.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022]
Abstract
Recent studies have suggested an important role of de novo mutations (DNMs) in neuropsychiatric disorders. As DNMs are not subject to elimination due to evolutionary pressure, they are likely to have greater disruptions on biological functions. While a number of sequencing studies have been performed on neuropsychiatric disorders, the implications of DNMs for drug discovery remain to be explored. In this study, we employed a gene-set analysis approach to address this issue. Four neuropsychiatric disorders were studied, including schizophrenia (SCZ), autistic spectrum disorders (ASD), intellectual disability (ID) and epilepsy. We first identified gene-sets associated with different drugs, and analyzed whether the gene-set pertaining to each drug overlaps with DNMs more than expected by chance. We also assessed which medication classes are enriched among the prioritized drugs. We discovered that neuropsychiatric drug classes were indeed significantly enriched for DNMs of all four disorders; in particular, antipsychotics and antiepileptics were the most strongly enriched drug classes for SCZ and epilepsy respectively. Interestingly, we revealed enrichment of several unexpected drug classes, such as lipid-lowering agents for SCZ and anti-neoplastic agents. By inspecting individual hits, we also uncovered other interesting drug candidates or mechanisms (e.g. histone deacetylase inhibition and retinoid signaling) that might warrant further investigations. Taken together, this study provided evidence for the usefulness of DNMs in guiding drug discovery or repositioning.
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Affiliation(s)
- Hon-Cheong So
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China; KIZ-CUHK Joint Laboratory of Bioresources, Molecular Research of Common Diseases, Kunming Zoology Institute of Zoology, China.
| | - Yui-Hang Wong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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James SN, Davis D, O'Hare C, Sharma N, John A, Gaysina D, Hardy R, Kuh D, Richards M. Lifetime affective problems and later-life cognitive state: Over 50 years of follow-up in a British birth cohort study. J Affect Disord 2018; 241:348-355. [PMID: 30144717 PMCID: PMC6137547 DOI: 10.1016/j.jad.2018.07.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Affective problems increase the risk of dementia and cognitive impairment, yet the life course dimension of this association is not clearly understood. We aimed to investigate how affective problems across the life course relate to later-life cognitive state. METHODS Data from 1269 participants from the Medical Research Council National Survey of Health and Development (NSHD, the British 1946 birth cohort) were used. Prospectively-assessed measures of affective symptoms spanning ages 13-69 and categorised into case-level thresholds. Outcomes consisted of a comprehensive measure of cognitive state (Addenbrooke's Cognitive Examination (ACE-III)), verbal memory, and letter search speed and accuracy at age 69. RESULTS Complementary life course models demonstrated that having 2 or more case-level problems across the life course was most strongly associated with poorer cognitive outcomes, before and after adjusting for sex, childhood cognition, childhood and midlife occupational position and education. LIMITATIONS A disproportionate loss to follow-up of those who had lower childhood cognitive scores may have led to underestimation of the strength of associations. DISCUSSION Using a population-based prospective study we provide evidence that recurrent lifetime affective problems predicts poorer later-life cognitive state, and this risk can be already manifest in early old age (age 69). Our findings raise the possibility that effective management to minimise affective problems reoccurring across the life course may reduce the associated risk of cognitive impairment and decline.
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Affiliation(s)
- Sarah-Naomi James
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Celia O'Hare
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Nikhil Sharma
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Amber John
- EDGE Lab, School of Psychology, University of Sussex, BN1 9RH, Brighton, United Kingdom
| | - Darya Gaysina
- EDGE Lab, School of Psychology, University of Sussex, BN1 9RH, Brighton, United Kingdom
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Diana Kuh
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Aging at UCL, 33 Bedford Place, WC1B 5JU, London, United Kingdom.
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Cooper SA, Smiley E, Allan L, Morrison J. Incidence of unipolar and bipolar depression, and mania in adults with intellectual disabilities: prospective cohort study. Br J Psychiatry 2018. [PMID: 29540250 DOI: 10.1192/bjp.2018.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incidence and determinants of affective disorders among adults with intellectual disabilities are unknown.AimsTo investigate affective disorder incidence, and determinants of unipolar depression, compared with general population reports. METHOD Prospective cohort study measuring mental ill health of adults with mild to profound intellectual disabilities living within a defined community, over 2 years. RESULTS There was 70% cohort retention (n = 651). Despite high mood stabiliser use (22.4%), 2-year incident mania at 1.1% is higher than the general population; 0.3% for first episode (standardised incident ratio (SIR) = 41.5, or 52.7 excluding Down syndrome). For any bipolar episode the SIR was 2.0 (or 2.5 excluding Down syndrome). Depression incidence at 7.2% is similar to the general population (SIR = 1.2), suggesting more enduring/undertreatment given the higher prevalence. Problem behaviours (odds ratio (OR) = 2.3) and life events (OR = 1.3) predict incident unipolar depression. CONCLUSIONS Depression needs improved treatment. Mania has received remarkably little attention in this population, despite high prevalence and incidence (similar to schizophrenia), and given the importance of clinician awareness for accurate differential diagnosis from attention-deficit hyperactivity disorder and problem behaviours.Declaration of interestNone.
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Affiliation(s)
- Sally-Ann Cooper
- Institute of Health and Wellbeing,University of Glasgow,Mental Health and Wellbeing Group,Gartnavel Royal Hospital,Glasgow
| | - Elita Smiley
- NHS Greater Glasgow and Clyde,Gartnavel Royal Hospital,Glasgow,UK
| | - Linda Allan
- Institute of Health and Wellbeing,University of Glasgow,Mental Health and Wellbeing Group,Gartnavel Royal Hospital,Glasgow,UK
| | - Jillian Morrison
- Institute of Health and Wellbeing,University of Glasgow,Mental Health and Wellbeing Group,Gartnavel Royal Hospital,Glasgow,UK
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A case series to examine whether people with learning disabilities can learn prerequisite skills for cognitive behavioural therapy. COGNITIVE BEHAVIOUR THERAPIST 2018. [DOI: 10.1017/s1754470x1700023x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAlthough cognitive behavioural therapy (CBT) is recommended for the treatment of a number of mental disorders among the general population, the ability of individuals with learning disabilities (LD) to understand CBT concepts and engage in CBT has been questioned. Aims: To examine whether specific prerequisite skills for CBT can be taught to people with LD using a newly developed training intervention and to investigate the acceptability of the intervention. Method: The study adopted a within-subjects case series research design. Quantitative assessment methods were used to evaluate the CBT skills of six adults with mild to moderate LD pre-intervention, following intervention and at 1-week follow-up. Participants were also asked to provide some qualitative feedback about how they had experienced the intervention. Results: The cognitive mediation skills and the ability of most participants to link activating events to emotions increased following intervention training and this improvement was maintained for four of them at follow-up. The feedback of participants regarding the process and content of the task demands was positive. Conclusions: The findings suggest that people with LD can learn some of the skills considered necessary to participate in CBT, such as cognitive mediation. However, further and more robust research is required to substantiate these findings.
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20
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Smiley E. Epidemiology of mental health problems in adults with learning disability: an update. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.11.3.214] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Epidemiological studies measuring prevalence rates and factors associated with mental health problems in adults with learning disability have produced very different and sometimes contradictory results, mainly because of methodological problems. Consequently, much of the epidemiology of mental health problems in this population is still unknown, although improved methodology and additional information are emerging. This article describes the methodological difficulties of studies, the reported prevalence rates in the context of these difficulties and what is currently known about the factors associated with mental health problems in this population.
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Hassiotis A, Tyrer P, Oliver P. Psychiatric assertive outreach and learning disability services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.9.5.368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Assertive outreach is a well-established method of managing patients with severe mental illness in the community. However, there is limited application and evidence of its efficacy in services for people with learning disabilities who also have mental illness. This paper elucidates current service provision for this group of patients and illustrates the pathways to mental health care available to them.
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Weeland MM, Nijhof KS, Otten R, Vermaes IPR, Buitelaar JK. Beck's cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 69:39-48. [PMID: 28806582 DOI: 10.1016/j.ridd.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/18/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
AIM This study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID. METHODS The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression. RESULTS The cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups. CONCLUSION The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. WHAT THIS PAPER ADDS?: Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.
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Affiliation(s)
- Martine M Weeland
- Academic Workplace Inside-Out, Behaviour Science Institute, Radboud University Nijmegen, The Netherlands; Pluryn Research & Development, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry, Ede, The Netherlands.
| | - Karin S Nijhof
- Academic Workplace Inside-Out, Behaviour Science Institute, Radboud University Nijmegen, The Netherlands; Pluryn Research & Development, Nijmegen, The Netherlands
| | - R Otten
- Academic Workplace Inside-Out, Behaviour Science Institute, Radboud University Nijmegen, The Netherlands; Pluryn Research & Development, Nijmegen, The Netherlands; The REACH Institute, Psychology Department, Arizona State University, Phoenix, USA
| | - Ignace P R Vermaes
- Academic Workplace Inside-Out, Behaviour Science Institute, Radboud University Nijmegen, The Netherlands; Pluryn Research & Development, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands; Radboudumc, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
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Smart D, Youssef GJ, Sanson A, Prior M, Toumbourou JW, Olsson CA. Consequences of childhood reading difficulties and behaviour problems for educational achievement and employment in early adulthood. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2017; 87:288-308. [PMID: 28266030 DOI: 10.1111/bjep.12150] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 01/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reading difficulties (RDs) and behaviour problems (BPs) are two common childhood problems that have a high degree of stability and often negatively affect well-being in both the short and longer terms. AIMS The study aimed to shed light on the unique and joint consequences of these two childhood problems for educational and occupational outcomes in early adulthood. SAMPLE Data were drawn from a life-course longitudinal study of psychosocial development, the Australian Temperament Project. METHODS Parent and teacher reports and a standard reading test were used to define four groups of children at 7-8 years: RDs only; BPs only; both problems; and neither problem. These groups were followed forward to ascertain educational attainment and employment status at 19-20 and 23-24 years. RESULTS Each childhood problem was a unique risk for poorer educational and occupational outcomes, with co-occurring problems significantly increasing the risk of poorer educational outcomes. Further analyses revealed that the effects of childhood BPs on occupational status were mediated by secondary school non-completion, but childhood RDs were not. CONCLUSIONS The findings point to the importance of screening and early intervention to prevent or minimize the development of these two childhood problems, as well as continuing to support vulnerable children to increase their likelihood of secondary school completion.
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Affiliation(s)
- Diana Smart
- Faculty of Health, Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - George J Youssef
- Faculty of Health, Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ann Sanson
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Margot Prior
- School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - John W Toumbourou
- Faculty of Health, Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Craig A Olsson
- Faculty of Health, Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
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Unwin G, Tsimopoulou I, Kroese BS, Azmi S. Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:60-75. [PMID: 26803286 DOI: 10.1016/j.ridd.2015.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/08/2015] [Accepted: 12/14/2015] [Indexed: 05/20/2023]
Abstract
Relatively little is known about the application of cognitive behavioural therapy (CBT) to people with intellectual disabilities (ID). This review sought to synthesise available evidence on the effectiveness of CBT for anxiety or depression to assess the current level of evidence and make recommendations for future research. A comprehensive systematic literature search was conducted to identify qualitative and quantitative studies. Robust criteria were applied to select papers that were relevant to the review. Included papers were subject to quality appraisal. Eleven out of the 223 studies considered met our inclusion criteria and were included in the review in which CBT was used with participants with ID and anxiety (n=3), depression (n=4) or a mixed clinical presentation (n=4). There remains a paucity of evidence of effectiveness, however, the studies indicate that CBT is feasible and well-tolerated and may be effective in reducing symptoms of depression among adults with mild ID. Qualitative data reflect a positive perception of CBT amongst clients and carers. Further research is required to investigate the components of CBT, suitability for CBT, and requisite skills for CBT, which uses valid, sensitive and more holistic outcome measures.
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Affiliation(s)
- Gemma Unwin
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Ioanna Tsimopoulou
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Biza Stenfert Kroese
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sabiha Azmi
- North East London NHS Foundation Trust, Good Mayes Hospital, Barley Lane, London, UK
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Pharmacological management of behavioral and psychiatric symptoms in older adults with intellectual disability. Drugs Aging 2016; 32:95-102. [PMID: 25573538 DOI: 10.1007/s40266-014-0236-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Given medical and social advances, the life expectancy of individuals with intellectual disability (ID) has increased dramatically, leading to a generation of older individuals with such disabilities. This review focuses on the pharmacological treatment of behavioral and psychiatric symptoms and disorders in older adults with ID. Older adults with ID often present with medical co-morbidities and mental health issues. Medication management of behavioral and psychiatric problems is complicated by a higher risk for adverse events, lack of decision-making capacity, and complex care networks. Some studies have shown that individuals with ID and co-morbid mental disorders are undertreated in comparison with those with similar disorders in the general population, resulting in poorer outcomes. However, older adults with ID are also at risk of polypharmacy, and older age is a risk factor for development of side effects. A general principle is that medication treatment for psychiatric disorders in older individuals with ID should be started at low dosages and increased cautiously while monitoring response and side effects. The use of psychotropic drugs for older individuals with ID and behavioral problems remains controversial, particularly in those with dementia.
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Sheehan R, Hassiotis A, Walters K, Osborn D, Strydom A, Horsfall L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015; 351:h4326. [PMID: 26330451 PMCID: PMC4556752 DOI: 10.1136/bmj.h4326] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. DESIGN Cohort study. SETTING 571 general practices contributing data to The Health Improvement Network clinical database. PARTICIPANTS 33,016 adults (58% male) with intellectual disability who contributed 211,793 person years' data. MAIN OUTCOME MEASURES Existing and new records of mental illness, challenging behaviour, and psychotropic drug prescription. RESULTS 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16,242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10,000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10,000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10,000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P<0.001), and new prescriptions of antipsychotics declined by 4% (3% to 5%) per year P<0.001) between 1999 and 2013. New prescriptions of mood stabilisers also decreased significantly. The rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour (incidence rate ratio 2.08, 95% confidence interval 1.90 to 2.27; P<0.001), autism (1.79, 1.56 to 2.04; P<0.001), and dementia (1.42, 1.12 to 1.81; P<0.003) and in those of older age, after control for other sociodemographic factors and comorbidity. CONCLUSIONS The proportion of people with intellectual disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with intellectual disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London (Royal Free Campus), London NW3 2PF, UK
| | - David Osborn
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - André Strydom
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Laura Horsfall
- Research Department of Primary Care and Population Health, University College London (Royal Free Campus), London NW3 2PF, UK
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Robinson KS. Part of the Team; Art Therapy with Pre-School Children with Developmental Delays and Disabilities in a Children's Treatment Centre Setting. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/08322473.2009.11434781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hartley SL, Esbensen AJ, Shalev R, Vincent LB, Mihaila I, Bussanich P. Cognitive Behavioral Therapy for Depressed Adults with Mild Intellectual Disability: A Pilot Study. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2015; 8:72-97. [PMID: 26925187 PMCID: PMC4767014 DOI: 10.1080/19315864.2015.1033573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND There is a paucity of research on psychosocial treatments for depression in adults with intellectual disability (ID). In this pilot study, we explored the efficacy of a group CBT treatment that involved a caregiver component in adults with mild ID with a depressive disorder. METHOD Sixteen adults with mild ID and a depressive disorder participated in a 10-week group CBT treatment and 8 adults with mild ID with a depressive disorder served as a treatment as usual (TAU) control group. Adults with mild ID and caregivers completed measures of depressive symptoms, behavior problems, and social skills at pre-treatment, post-treatment, and a 3-month follow-up. Adults with mild ID also completed a series of tasks to measure their understanding of the principles of cognitive therapy pre- and post-treatment. RESULTS The CBT group demonstrated significant decreases in depressive symptoms and behavior problems from pre-treatment to post-treatment and these effects were maintained at a 3-month follow-up. The CBT group demonstrated significant improvements in their ability to infer emotions and thoughts based on various situation-thought-emotion pairings from pre-treatment to post-treatment. CONCLUSIONS Findings indicate that adults with mild ID with a depressive disorder benefitted from a group CBT treatment with a caregiver component. Moreover, adults with mild ID appeared to benefit, at least in part, from the cognitive therapy components of the treatment, in addition to the behavior therapy components.
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Affiliation(s)
- Sigan L Hartley
- Univeristy of Wisconsin, Waisman Center, 1500 Highland Ave, Madison, 53705 United States
| | - Anna J Esbensen
- Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, 3333 Burnet Ave, ML 4002, Cincinnati, 45229 United States
| | - Rebecca Shalev
- University of Wisconsin-Madison, School Psychology, Madison, United States
| | - Lori B Vincent
- university of Wisconsin-Madison, School Psychology, Madison, United States
| | - Iulia Mihaila
- University of Wisconsin-Madison, Waisman Center, Madison, United States
| | - Paige Bussanich
- University of Wisconsin-Madison, Waisman Center, Madison, United States
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Mileviciute I, Hartley SL. Self-reported versus informant-reported depressive symptoms in adults with mild intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:158-69. [PMID: 23902265 PMCID: PMC4031298 DOI: 10.1111/jir.12075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Virtually nothing is known about potential differences in the types of depression symptoms reported by adults with mild intellectual disability (ID) on self-reported questionnaires as compared with the types of symptoms reported by caregivers on informant questionnaires. Moreover, little is known about how the presentation of depression among adults with mild ID varies based on socio-demographic characteristics. METHODS We compared findings from two self-reported questionnaires, the Self-Reported Depression Questionnaire (SRDQ) and the Glasgow Depression Scale for People with a Learning Disability (GDS), to that of an informant questionnaire of depressive symptoms, the Glasgow Depression Scale--Caregiver Supplement (CGDS), in 80 adults with mild ID. We also examined the association between age, sex, IQ and the presence of a co-occurring psychiatric disorder and frequency of affective, cognitive and somatic depressive symptoms in our sample of adults with mild ID. RESULTS Adults with mild ID self-reported a higher frequency of affective and cognitive depressive symptoms than staff reported on the informant measure. Staff reported a higher frequency of somatic symptoms than adults with mild ID on one of the self-reported questionnaires (GDS) and a similar frequency on the other self-reported questionnaire (SRDQ). Important differences were found in the types of depressive symptoms based on their IQ, age and presence of a co-occurring psychiatric disorder. CONCLUSION Informant questionnaires offer valuable information, but assessment should include self-reported questionnaires as these questionnaires add unique information about internalised experiences (affective and cognitive symptoms) of adults with mild ID that may not be apparent to caregivers. Health care providers should be made aware of the important differences in the presentation of depressive based on their IQ, age and presence of a co-occurring psychiatric disorder.
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Richards M, Barnett JH, Xu MK, Croudace TJ, Gaysina D, Kuh D, Jones PB. Lifetime affect and midlife cognitive function: prospective birth cohort study. Br J Psychiatry 2014; 204:194-9. [PMID: 24357571 PMCID: PMC3939442 DOI: 10.1192/bjp.bp.113.128942] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrent affective problems are predictive of cognitive impairment, but the timing and directionality, and the nature of the cognitive impairment, are unclear. AIMS To test prospective associations between life-course affective symptoms and cognitive function in late middle age. METHOD A total of 1668 men and women were drawn from the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Longitudinal affective symptoms spanning age 13-53 years served as predictors; outcomes consisted of self-reported memory problems at 60-64 years and decline in memory and information processing from age 53 to 60-64 years. RESULTS Regression analyses revealed no clear pattern of association between longitudinal affective symptoms and decline in cognitive test scores, after adjusting for gender, childhood cognitive ability, education and midlife socioeconomic status. In contrast, affective symptoms were strongly, diffusely and independently associated with self-reported memory problems. CONCLUSIONS Affective symptoms are more clearly associated with self-reported memory problems in late midlife than with objectively measured cognitive performance.
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Hulbert-Williams L, Hastings R, Owen DM, Burns L, Day J, Mulligan J, Noone SJ. Exposure to life events as a risk factor for psychological problems in adults with intellectual disabilities: a longitudinal design. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:48-60. [PMID: 23627774 DOI: 10.1111/jir.12050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 05/07/2023]
Abstract
BACKGROUND Several cross-sectional studies have shown an association between exposure to life events and psychological problems in adults with intellectual disability (ID). To establish life events as a risk factor, prospective designs are needed. METHODS Support staff informants provided data on the psychological problems of 68 adults with ID and their recent exposure to life events. Using data collected on the same sample 3.5 to 4 years earlier, prospective analysis of the relationships between life events exposure and psychological problems over time was explored. RESULTS Hierarchical linear regression analyses demonstrated a contribution of life events to the prediction of later psychological problems after controlling for earlier psychological problems. Exploratory analyses showed that the relationship between life events and psychological problems might be unidirectional, and non-spurious; remaining present once the impact of other correlates of psychological problems was controlled. CONCLUSIONS These data offer support for the status of life events (with a negative valence) as a risk factor for psychological problems in adults with ID. To establish life events as a causal risk factor, research is needed to examine the mechanisms via which life events have their impact on psychological well-being.
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Affiliation(s)
- L Hulbert-Williams
- School of Applied Sciences, University of Wolverhampton, Wolverhampton, UK
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Hassiotis A, Serfaty M, Azam K, Strydom A, Blizard R, Romeo R, Martin S, King M. Manualised Individual Cognitive Behavioural Therapy for mood disorders in people with mild to moderate intellectual disability: a feasibility randomised controlled trial. J Affect Disord 2013; 151:186-95. [PMID: 23827533 DOI: 10.1016/j.jad.2013.05.076] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evaluation of complex interventions, including standardisation of the intervention, types of outcomes selected and measures of change, is a fairly novel concept in the field of intellectual disabilities. Our aim was to explore these issues in a feasibility study of Manualised Individual Cognitive Behaviour Treatment (M-iCBT) compared to the treatment as usual alone (TAU). METHODS Service users with mild to moderate intellectual disability experiencing a mood disorder or symptoms of depression and/or anxiety (mini PAS-ADD total score >10 or 7 respectively) were randomly assigned to either. RESULTS In total, 32 participants were randomly assigned to 16 sessions of M-iCBT (n=16) in addition to TAU or TAU alone (n=16). We explored recruitment and accrual rates, willingness to participate, acceptability of the intervention and suitability of assessment tools. Mean change (95% CI) in the Beck Depression Inventory-Youth (BDI-Y) score from baseline to the 16 week endpoint (primary variable) was 0.10 (95% CI: -8.56, 8.76) and in the Beck Anxiety Inventory-Youth (BAI-Y) 2.42 (95% CI: -5.27, 10.12) in favour of TAU. However, there was a clear trend in favour of CBT in depressed participants with or without anxiety. LIMITATIONS The intervention targeted both depression and anxiety following a transdiagnostic model. This may have impacted the anticipated size of change in the primary outcome. The precise impact of cognitive limitations on ability to use therapy effectively is not fully understood. CONCLUSIONS This study demonstrates that it is feasible to carry out a pragmatic randomised controlled trial of M-iCBT for people with mild to moderate intellectual disability. However, uncertainties about its clinical and cost effectiveness can only be fully answered by further examination of its superiority against other treatments.
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Affiliation(s)
- Angela Hassiotis
- UCL Mental Health Sciences Unit, 1st Floor, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
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Olubokun J, Menon K. Rapid Cycling Affective Disorder Presenting as Challenging behaviour in a Service User with Mild Learning Disability – Case Report. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979504799103895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pruijssers A, van Meijel B, van Achterberg T. A case report for diagnosing anxiety in people with intellectual disability: the role of nurses in the application of a multidimensional diagnostic guideline. Perspect Psychiatr Care 2011; 47:204-12. [PMID: 21950367 DOI: 10.1111/j.1744-6163.2010.00294.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this article is the presentation of a multidimensional guideline for the diagnosis of anxiety and anxiety-related behavior problems in people with intellectual disability (ID), with a substantial role for the nurse in this diagnostic process. DESIGN AND METHODS The guideline is illustrated by a case report of a woman with ID with severe problems. FINDINGS It appears that a multidimensional diagnostic approach involving multidisciplinary team efforts can result in a more accurate diagnosis and improved subsequent treatment. PRACTICE IMPLICATIONS Nurses should be engaged in the diagnostic process because of their ability to make direct observations and to actively participate in carrying out all parts of the guideline.
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Affiliation(s)
- Addy Pruijssers
- Institute of Advanced Studies and Applied Research, INHolland University, Amsterdam, The Netherlands.
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Elovainio M, Ferrie JE, Singh-Manoux A, Shipley M, Batty GD, Head J, Hamer M, Jokela M, Virtanen M, Brunner E, Marmot MG, Kivimäki M. Socioeconomic differences in cardiometabolic factors: social causation or health-related selection? Evidence from the Whitehall II Cohort Study, 1991-2004. Am J Epidemiol 2011; 174:779-89. [PMID: 21813793 PMCID: PMC3176829 DOI: 10.1093/aje/kwr149] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In this study, the health-related selection hypothesis (that health predicts social mobility) and the social causation hypothesis (that socioeconomic status influences health) were tested in relation to cardiometabolic factors. The authors screened 8,312 United Kingdom men and women 3 times over 10 years between 1991 and 2004 for waist circumference, body mass index, systolic and diastolic blood pressure, fasting glucose, fasting insulin, serum lipids, C-reactive protein, and interleukin-6; identified participants with the metabolic syndrome; and measured childhood health retrospectively. Health-related selection was examined in 2 ways: 1) childhood health problems as predictors of adult occupational position and 2) adult cardiometabolic factors as predictors of subsequent promotion at work. Social causation was assessed using adult occupational position as a predictor of subsequent change in cardiometabolic factors. Hospitalization during childhood and lower birth weight were associated with lower occupational position (both P’s ≤ 0.002). Cardiometabolic factors in adulthood did not consistently predict promotion. In contrast, lower adult occupational position predicted adverse changes in several cardiometabolic factors (waist circumference, body mass index, fasting glucose, and fasting insulin) and an increased risk of new-onset metabolic syndrome (all P’s ≤ 0.008). These findings suggest that health-related selection operates at younger ages and that social causation contributes to socioeconomic differences in cardiometabolic health in midlife.
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Affiliation(s)
- Marko Elovainio
- Department of Epidemiology and Public Health, UCL Medical School, University College London, United Kingdom.
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Kilbane AL, Jahoda A. Therapy Expectations: Preliminary Exploration and Measurement in Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1468-3148.2011.00630.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Richards M, Hatch SL. A life course approach to the development of mental skills. J Gerontol B Psychol Sci Soc Sci 2011; 66 Suppl 1:i26-35. [PMID: 21398418 PMCID: PMC3355296 DOI: 10.1093/geronb/gbr013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A wide variety of factors across the life course jointly influence cognitive and emotional development. Indeed, research from a variety of disciplines strongly suggests that cognition and mental health are intertwined across the life course, by their common antecedents and underlying physiology in development and in their interplay across adult and later life. We suggest that cognitive and socioemotional function fuse to form skills for life supporting self-regulation, competence, and quality of life that persist into later life through linked reciprocal processes of genetic influence, nurturing, schooling, work, and lifestyle.
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Affiliation(s)
- Marcus Richards
- Medical Research Council Unit for Lifelong Health and Ageing, London, UK.
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Hassiotis A, Serfaty M, Azam K, Strydom A, Martin S, Parkes C, Blizard R, King M. Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial. Trials 2011; 12:95. [PMID: 21492437 PMCID: PMC3102627 DOI: 10.1186/1745-6215-12-95] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/14/2011] [Indexed: 11/12/2022] Open
Abstract
Background Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial. Methods Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes. Discussion The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities. Trial registration ISRCTN: ISRCTN38099525
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Affiliation(s)
- Angela Hassiotis
- Department of Mental Health Sciences, University College Medical School, Charles Bell House, 67-73 Riding House Street, London W1W 7EY, UK.
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Prevalence and predictors of suicidal behaviour in a sample of adults with estimated borderline intellectual functioning: results from a population survey. J Affect Disord 2011; 129:380-4. [PMID: 21071092 DOI: 10.1016/j.jad.2010.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to investigate, for the first time, rates of suicidal behaviour (ideation and acts) in people with borderline intellectual functioning in a general population sample, and to compare these to rates in people with normal functioning. METHODS We used data from the third Adult Psychiatric Morbidity Survey, carried out in England in 2007. It was designed to be representative of people living in private households. The analyses are based on 6872 individuals. RESULTS 1053 (16.1%) participants met criteria for borderline intellectual functioning. People with borderline intellectual functioning were more likely to report ever having made a suicidal attempt or to have harmed themselves without the intention of taking their own life (Odds Ratio for both 1.7, 95% Confidence Interval 1.3-2.2). These associations were no longer significant after controlling for income and age. LIMITATIONS Our sample did not include people living in segregate environments, who were likely to display challenging behaviours, and have higher rates of self harm. CONCLUSION The increased rates of suicidal behaviour found in people with borderline intellectual functioning were explained by younger age and socioeconomic disadvantages, although the association is likely to be complex. Our findings would strongly support targeting those at the lower range of intelligence with interventions for suicide prevention.
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Søndenaa E, Nygård Ø, Nøttestad JA, Linaker OM. Validation and adaptation of the Norwegian version of Hayes Ability Screening Index for intellectual difficulties in a psychiatric sample. Nord J Psychiatry 2011; 65:47-51. [PMID: 20465512 DOI: 10.3109/08039488.2010.486444] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intellectual disabilities (ID) among psychiatric patients have traditionally been neglected. A lack of convenient instruments and competency in ID may have worsened the conditions and treatment availability for these patients. AIMS Validation and adaptation of a screening instrument for ID (Hayes Ability Screening Index; HASI) in a psychiatric hospital setting. METHODS This is a cross-sectional study of 50 psychiatric patients in two Norwegian psychiatric hospitals comparing results of the HASI with the Wechsler Abbreviated Scale of Intelligence (WASI). RESULTS The HASI correlated well with the standard IQ test used (r= 0.67, P< 0.001). At a stated cut-off score of 85, the HASI had a sensitivity of 100% and specificity of 34%. CONCLUSIONS The HASI is a valid and time-saving screening instrument for ID among psychiatric patients. The prescribed cut-off score, however, resulted in a large number of false positives.
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Affiliation(s)
- Erik Søndenaa
- Forensic Department Brøset, Center for Research and Education in Forensic Psychiatry, P.O. 1803 Lade, 7440 Trondheim, Norway.
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Lunsky Y, Balogh R. Dual diagnosis: A national study of psychiatric hospitalization patterns of people with developmental disability. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:721-8. [PMID: 21070700 DOI: 10.1177/070674371005501106] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report national demographics and diagnostic profiles of people with developmental disability hospitalized for psychiatric reasons, and to contrast results to psychiatric hospitalizations among patients with no comorbid developmental disability. METHOD People with developmental disability across Canada were identified using data administered by the Canadian Institute for Health Information. Among this cohort of people with developmental disability, records of hospitalization for psychiatric reasons were aggregated for the 2005/06 fiscal year (April 2005 to March 2006). Descriptive statistics on province of residence, age, sex, specific diagnoses, length of stay, and hospitalization frequency were calculated and compared with people without developmental disability. RESULTS In Canada, people with developmental disability were hospitalized a total of 8378 times in 2005/06; among these, 3478 (42%) were for psychiatric conditions. The number of people with developmental disability hospitalized for a psychiatric condition represents about 2% of the general population hospitalized for such conditions. Among people with developmental disability hospitalized for a psychiatric condition most were men and people aged between 15 and 34 years. For almost all psychiatric disorder categories, people with developmental disability were hospitalized at rates significantly different than their counterparts without developmental disability. Lengths of hospital stays for psychiatric conditions were very similar when comparing the study groups; however, people with developmental disability were more likely to have 2 or more hospitalizations during the year. CONCLUSIONS People with developmental disability display unique hospitalization patterns, compared with the general population.
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Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario.
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Finlayson J, Morrison J, Jackson A, Mantry D, Cooper SA. Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:966-980. [PMID: 21040056 DOI: 10.1111/j.1365-2788.2010.01319.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Injuries are among the leading causes of death and disability in the world and a major public health concern. Falls are a common cause. Young persons with intellectual disabilities (ID) have a higher rate and different pattern of injuries than the general population, but little is known regarding adults. METHODS The aim of this study was to determine the incidence and types of injuries experienced by a community-based cohort of adults with ID (n = 511) in a 12-month period. Face-to-face interviews were conducted with participants 2 years after they had first been recruited into a longitudinal study. RESULTS Incidence of at least one injury in a 12-month period was 20.5% (105), of which 12.1% (62) was because of falls. Incident injury was predicted by having epilepsy and not having autism. Incident fall injury was predicted by urinary incontinence, while Down syndrome reduced risk. CONCLUSIONS Adults with ID do experience a higher rate of injuries and falls when compared with the general population. The results of this study highlight this, and hence the need to work towards the development of interventions for injury and falls prevention in this population.
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Affiliation(s)
- J Finlayson
- Section of Psychological Medicine, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK
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Abstract
The survivors of the initial years of neonatal intensive care of preterm infants reached adulthood during the last decade. Reports of their adult outcomes examined have included neurodevelopmental, behavioral and health outcomes as well as social functioning and reproduction. Despite statistically significant differences between preterm young adults and controls in most outcomes studied, the majority of preterm survivors do well and live fairly normal lives. The two major predictors of adult outcomes are lower gestational age that reflect perinatal injury and family sociodemographic status which reflects both genetic and environmental effects.
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Abstract
PURPOSE OF REVIEW Adults with intellectual disabilities experience higher rates of mental ill health than the general population. Despite this, the epidemiological knowledge base remains limited. The purpose of this article is to review mental health epidemiological studies relevant to adults with intellectual disabilities, published since January 2008. RECENT FINDINGS Several studies have aimed to build the epidemiological evidence base, particularly with regards to problem behaviours, which appear to be remitting-relapsing conditions rather than necessarily being chronic. Most of such work confirms prevalence and incidence rates, and conducts exploratory analyses to determine factors independently related to mental ill health. Down syndrome protects against problem behaviours and mental ill health (except dementia that occurs at a higher rate), whereas epilepsy does not appear to affect risk for mental ill health. Dementia is four times more common in older persons with intellectual disabilities without Down syndrome than in the general population. Persons with borderline intellectual disabilities also experience higher rates of mental ill health than the general population, but receive fewer treatments. SUMMARY This work builds usefully upon previous studies. Further hypothesis-based analyses are needed.
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Hartley SL, Maclean WE. Depression in adults with mild intellectual disability: role of stress, attributions, and coping. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2009; 114:147-60. [PMID: 19374469 PMCID: PMC2831402 DOI: 10.1352/1944-7588-114.3.147] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The experience of stressful social interactions, negative causal attributions, and the use of maladaptive coping efforts help maintain depression over time in the general population. We investigated whether a similar experience occurs among adults with mild intellectual disability. We compared the frequency and stress impact of such interactions, identified causal attributions for these interactions, and determined the coping strategies of 47 depressed and 47 nondepressed adults with mild intellectual disability matched on subject characteristics. The depressed group reported a higher frequency and stress impact of stressful social interactions, more negative attribution style, and more avoidant and less active coping strategies did than the nondepressed group. Findings have implications for theory building and development of psychotherapies to treat depression.
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Thomson A, Maltezos S, Paliokosta E, Xenitidis K. Risperidone for attention-deficit hyperactivity disorder in people with intellectual disabilities. Cochrane Database Syst Rev 2009; 2009:CD007011. [PMID: 19370667 PMCID: PMC7387848 DOI: 10.1002/14651858.cd007011.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is increasingly recognised as occurring in people with intellectual disability (ID), although treatment of ADHD in this population has not ben tested widely. Risperidone has been used to treat ADHD in people with ID, although the evidence for its effectiveness is unclear. OBJECTIVES To examine the effectiveness of risperidone for the treatment of attention deficit hyperactivity disorder in people with intellectual disabilities. SEARCH STRATEGY In February 2009, MEDLINE, PsycINFO, EMBASE, AMED, ISI Web of Science and WorldCat Dissertations were searched using an extensive list of synonyms for ADHD and ID. CENTRAL, CCDPLP, Current Controlled Trials meta-register (mRCT), CenterWatch, NHS National Research Register, clinicaltrials.gov were searched, pharmaceutical companies and experts in the field were contacted. Reference lists of review articles were examined and citation searches were performed in ISI Web of Knowledge. SELECTION CRITERIA All randomised controlled trials (RCTs), both published and unpublished, in any language, in which children or adults with ADHD and ID were treated with risperidone. DATA COLLECTION AND ANALYSIS Data collection and analyses were planned but not performed due to a lack of suitable studies. MAIN RESULTS Eleven studies were considered but none were suitable for inclusion. AUTHORS' CONCLUSIONS There is no evidence from RCTs that risperidone is effective for the treatment of ADHD in people with ID. Prescribing in this population can only be based on open-label studies or extrapolation from research in people with autism and disruptive behaviour disorders; however these studies have not investigated people with ID separately so there are reservations regarding the applicability of these findings. Research into effectiveness and tolerability is urgently needed.
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Affiliation(s)
- Alex Thomson
- Section of Brain Maturation (P050), Kings College London, Institute of Psychiatry, De Crespigny Park, London, UK, SE5 8AF.
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Cooper SA, Smiley E, Allan LM, Jackson A, Finlayson J, Mantry D, Morrison J. Adults with intellectual disabilities: prevalence, incidence and remission of self-injurious behaviour, and related factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:200-216. [PMID: 18444987 DOI: 10.1111/j.1365-2788.2008.01060.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) is a serious condition, with implications for the person, their family and financial costs to the state providing care. The previously reported prevalence of SIB has ranged from 1.7% to 41%, or 1.7%-23.7% in community studies. There has been little study of remission rate, and incidence has not previously been reported. SIB has been reported to be individually associated with lower ability, autism and communication impairments, but given the inter-relationships between these three factors, it is not known whether they are independently associated with SIB. This study investigates the point prevalence, incidence and remission rates of SIB among the adult population with intellectual disabilities (ID), and explores which factors are independently associated with SIB. METHOD A prospective cohort study design was used in a general community setting. The participants were all adults (16 years and over) with ID in a defined geographical area. Individual assessments were conducted with all participants. RESULTS The point prevalence of SIB (as defined by DC-LD) was 4.9%, the two-year incidence was 0.6%, and two-year remission rate was 38.2%. Independently related to SIB were: lower ability level, not living with a family carer, having attention deficit hyperactivity disorder, visual impairment, and not having Down syndrome. Other factors, including communication impairment, autism, and level of deprivation of the area resided within, were not related. CONCLUSIONS SIB is not as enduring and persistent as previously thought; a significant proportion gains remission in this time period. This should provide hope for families, paid carers and professionals, and reduce therapeutic nihilism. Our study is a first tentative step towards identifying risk-markers for SIB, and developing aetiological hypotheses for subsequent testing. The extent to which SIB may be a relapsing-remitting (episodic) condition requires further investigation, so does further hypothesis-based investigation of factors that might be predictive of incidence of, and remission from, SIB.
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Affiliation(s)
- S-A Cooper
- Section of Psychological Medicine, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK.
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Cooper SA, Smiley E, Jackson A, Finlayson J, Allan L, Mantry D, Morrison J. Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:217-232. [PMID: 19178617 DOI: 10.1111/j.1365-2788.2008.01127.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Aggressive behaviours can be disabling for adults with intellectual disabilities (ID), with negative consequences for the adult, their family and paid carers. It is surprising how little research has been conducted into the epidemiology of these needs, given the impact they can have. This study investigates point prevalence, 2-year incidence and 2-year remission rates for aggressive behaviour (physically aggressive, destructive and verbally aggressive), and it investigates which factors are independently associated with aggressive behaviour. METHODS All adults with ID - within a geographically defined area of Scotland, UK - were recruited to a longitudinal cohort. At baseline, assessments were undertaken of demography, lifestyle, supports, development, problem behaviours, disabilities and physical and mental health. These were repeated for a 2-year period. RESULTS At baseline, the participation rate was 1023 (65.5%). After 2 years, the cohort retention was 651 adults. The point prevalence of Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) aggressive behaviour was 9.8% (95% confidence interval = 8.0-11.8%), 2-year incidence was 1.8%, and 2-year remission rate from all types of aggressive behaviour meeting DC-LD criteria was 27.7%. The factors independently associated with aggressive behaviours were lower ability, female gender, not living with a family carer, not having Down syndrome, having attention-deficit hyperactivity disorder and having urinary incontinence. Incidence of aggressive behaviour meeting DC-LD criteria in adult life is similar to that for each of psychotic, anxiety and organic disorders. CONCLUSIONS Aggressive behaviour is common among adults with ID, but contrary to previous suggestions, more than a quarter remit within the short to medium term. This is important knowledge for professionals as well as the person and her/his family and paid carers. There is much yet to learn about the mechanisms underpinning aetiology and maintenance of aggressive behaviour in this population, and exploratory epidemiological investigations such as this have a role to play in progressing research towards further hypothesis testing and trials to influence clinical practice, service development and policy.
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Affiliation(s)
- S-A Cooper
- Section of Psychological Medicine, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK.
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Perez-Achiaga N, Nelson S, Hassiotis A. Instruments for the detection of depressive symptoms in people with intellectual disabilities: a systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2009; 13:55-76. [PMID: 19332509 DOI: 10.1177/1744629509104487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Affective disorders, particularly depression, are common in adults with intellectual disabilities. However the detection of these disorders is hindered by the varied presentation of depressive symptoms across the range of intellectual disability. We undertook a systematic review of the available English-language diagnostic instruments for depressive disorders for adults with all levels of intellectual disability. We appraised the studies based on the instruments' psychometric properties, sensitivity and specificity. We included 21 of 28 identified studies which contained original data on validity and reliability; the ;gold standard' ranged from clinical opinion to other established instruments, some of which had limited validation in people with intellectual disability. In view of the benefits of psychological treatments for common mental disorders, it is important to develop instruments to be used in monitoring cognitive as well as behavioural outcomes for people with intellectual disability and depressive disorders.
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