Access to and perceived unmet need for mental health services and support in a community sample of UK adolescents with and without experience of childhood adversity

AIMS

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students.

METHODS

We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS).

RESULTS

Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR) = 1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR = 1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR) = 1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR = 0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR = 1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR = 0.85; 95% CI: 0.78-0.91).

CONCLUSIONS

Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Sociodemographic disparities in non-diabetic hyperglycaemia and the transition to type 2 diabetes: evidence from the English Longitudinal Study of Ageing

AIM

To explore whether there are social inequalities in non-diabetic hyperglycaemia (NDH) and in transitions to type 2 diabetes mellitus and NDH low-risk status in England.

METHODS

Some 9143 men and women aged over 50 years were analysed from waves 2, 4, 6 and 8 (2004-2016) of the English Longitudinal Study of Ageing (ELSA). Participants were categorized as: NDH 'low-risk' [HbA_1c < 42 mmol/mol (< 6.0%)], NDH [HbA_1c 42-47 mmol/mol (6.0-6.4%)] and type 2 diabetes [HbA_1c > 47 mmol/mol (> 6.4%)]. Logistic regression models estimated the association between sociodemographic characteristics and NDH, and the transitions from NDH to diagnosed or undiagnosed type 2 diabetes and low-risk status in future waves.

RESULTS

NDH was more prevalent in older participants, those reporting a disability, those living in deprived areas and in more disadvantaged social classes. Older participants with NDH were less likely to progress to undiagnosed type 2 diabetes [odds ratio (OR) 0.27, 95% confidence interval (CI) 0.08, 0.96]. NDH individuals with limiting long-standing illness (OR 1.72, 95% CI 1.16, 2.53), who were economically inactive (OR 1.60, 95% CI 1.02, 2.51) or from disadvantaged social classes (OR 1.63, 95% CI 1.02, 2.61) were more likely to progress to type 2 diabetes. Socially disadvantaged individuals were less likely (OR 0.64, 95% CI 0.41, 0.98) to progress to NDH low-risk status.

CONCLUSIONS

There were socio-economic differences in NDH prevalence, transition to type 2 diabetes and transition to NDH low-risk status. Disparities in transitions included the greater likelihood of disadvantaged social groups with NDH developing type 2 diabetes and greater likelihood of advantaged social groups with NDH becoming low-risk. These socio-economic differences should be taken into account when targeting prevention initiatives.

Differences between Extraverts and Intraverts on a Button-Pressing Task

A simple linear display consisting of five buttons was used to test an extravert, an intravert, and an intermediate group to see whether differences in over-all response rate or pattern appeared initially, and whether these were affected by satiation on a restricted portion of the display (two end buttons). It was found that no significant shift due to satiation occurred but that extraverts were the most responsive group both before and after satiation. This does not seem to agree with Eysenck's theory but an explanation has been suggested to the present writer by Dr. Eysenck.

Birth Order, Family Structure and Personality Variables

The birth order and family structure variables assessed included first or only child, position in multi-child family, position in dyadic family, age of parents at birth of given child, whether reared by one or both parents, whether reared under permissive or authoritarian family atmosphere. The personality variables assessed included Sociability, Anxiety, Dominance, Superego, Phlegmatic Temperament, Involvement, Self-Regard and other scales measured by the Howarth Personality Questionnaire. One hundred seventy female and 142 male undergraduates were tested. Significant relationships found included: anxiety lower in firstborns; superego higher in firstborns; persistence higher in those not dominated by elder sibling; phlegmatic temperament higher in permissive families; involvement and phlegmatic temperament lower in single parent families; self-pride higher in the elder of a sibling pair; individual tolerance higher in children reared by both rather than single parent.

mproved pregnancy outcome in a patient with renal allograft nephropathy undergoing temporary hemodialysis

We report a case of a woman with a poorly functioning renal allograft and a positive anti-cardiolipin antibody who was dialysis-independent and conceived 18 months following her transplant. She was electively maintained on hemodialysis during the pregnancy and delivered a live infant at 31 weeks gestation. Her renal function returned to prepregnancy levels post partum and she remained dialysis-independent.

To transfuse or not to transfuse: iatrogenic compromise of women's reproductive careers

A 21-year-old Indo-Asian woman, who had arrived in the UK 5 months before presentation, consulted her general practitioner because of tiredness and shortness of breath on climbing stairs. There were no significant factors in her history, except that she did not eat red meat. Initial investigation revealed a severe anaemia with a haemoglobin (Hb) concentration of 4.6 g/dl, mean cell volume (MCV) of 49.4 fl, mean cell haemoglobin (MCH) of 11.5 pg, white cell count of 7.4 × 109/litre and a platelet count of 583 × 109/litre. She was promptly referred as an emergency to a general medical ward in a teaching hospital for further management. On admission, physical examination revealed pallor and a tachycardia of 110 beats/minute, but there ware no other significant findings. Her electrocardiogram was normal and there was no evidence of cardiac failure on chest X-ray. She was transfused three units of packed red cells. Subsequently she underwent further investigations, including Hb electrophoresis, vitamin B12 and folate levels, ferritin and transferrin levels, serum urea and electrolytes, liver function tests, blood film for malarial parasites, endomysial and gliadine antibodies, and comprehensive gastrointestinal tract work-up. All investigations were negative with the exception of a positive anti-gliadine immunoglobulin G. The diagnosis of iron deficiency anaemia of unknown cause was made. The patient was given dietary advice and was discharged back under her GP's care 6 months later, having maintained a normal Hb.

What does Eysenck's psychoticism scale really measure?

The following sources of evidence are discussed in order to examine the component parts-in terms of primary traits-of Eysenck's psychoticism scale, which he refers to as a 'superfactor' but which is here viewed as a composite or complex of primary traits. Factor analytic studies by the author and by Barratt & Kline not only showed agreement as to factor composition but also each found a psychoticism factor and supply evidence as to the question posed. Additionally a correlational study by the author and a study by Eysenck supply evidence. Thus from factor analytic and correlational evidence a high P scorer possesses these traits: impulsiveness, lack of cooperation, oral pessimism, rigidity, low superego controls, low social sensitivity, low persistence, lack of anxiety and lack of feelings of inferiority. Of the three main 'superfactors' advocated by Eysenck-neuroticism (N), extraversion (E) and psychoticism (P)-the evidence indicated that psychoticism was the least univocal.

Introversion and neuroticism: a persistent relationship

A relationship between neurotic tendency and introversion has been around since 1924 insofar as test instruments are concerned (we are not concerned herein with speculation per se). Does it still persist? The writer has recently found a significant relationship between Eysenck's main scales for these tendencies which persists despite Eysenck's efforts to obtain scale independence. Similarly, Comrey, who has developed more recent measures of introversion and neuroticism, reports a correlation of .41. We need to know more about the components of sociability-directed scales for extraversion-introversion as well as about bridging factors such as inferiority.

A multidimensional approach to the relationship between mood and weather

Ten mood variables were related to eight weather variables in a multidimensional study. Data were collected from 24 male subjects over 11 consecutive days. The mood variables were as follows: concentration, cooperation, anxiety, potency, aggression, depression, sleepiness, scepticism, control, and optimism. The weather variables included: hours of sunshine, precipitation, temperature, wind direction, wind velocity, humidity, change in barometric pressure and absolute barometric pressure. Humidity, temperature and hours of sunshine had the greatest effect on mood. High levels of humidity lowered scores on concentration while increasing reports of sleepiness. Rising temperatures lowered anxiety and scepticism mood scores. Humidity was the most significant predictor in regression and canonical correlation analysis. Implications for school and office performance are discussed which highlight the importance of humidity as a weather variable.

Self-report multiple mood instruments

Some dozen mood measurement instruments are surveyed with an emphasis on multiplicity of mood measurement with applications reviewed under topic headings as follows: Mood scales, Group studies, Drugs and drug use, Alcohol and mood, Mood and smoking behaviour, Birth control and menstrual cycle, Mood and hypnotizability, Sleep and mood, Age, sex and mood, Mood and aesthetics, Mood state manipulation, Scale development and relationships, Recommendations. It is pointed out that any scale to be recommended to prospective users should (a) be relatively easy for self-administration, (b) have unambiguous scales, (c) be easy to score, (d) be quite short in administration time, (e) provide the maximum possible information.

Psychoticism, neuroticism, and control as major dimensions of mood variation

Two sets of self-evaluative mood adjective scales were factored to yield mood variation patterns over a 30-day period. Each set of data produced factors of psychoticism, neuroticism (anxiety), and control. Although the psychoticism trait factor has been described recently in detail by Eysenck and Eysenck (1976), it has not been previously reported as a state factor.

Mood variation patterns based on factor analysis

10 mood scales were self-administered by two subjects, one male and one female, over a 30-day period. Mood evaluations were obtained morning and evening for a total of 600 measurements per subject to study personality by P-technique. Factor analysis yielded more factors in the evening data than in the morning mood variation. Factors included arousal, superego, and sociability.

A COMPREHENSIVE FACTOR ANALYSIS OF PERSONALITY QUESTIONNAIRE ITEMS: A TEST OF TWENTY PUTATIVE FACTOR HYPOTHESES

The purpose of the present study was to evaluate twenty putative factor hypotheses (PFH's) of personality using various rotation methods, both orthogonal and oblique. In order to obtain a representative item pool, the literature was surveyed, with special attention to factor analytic studies. The test sources provided 1726 non-repeated items, from which 400 items, representing 20 PFH's, were selected. A balanced questionnaire consisting of items reworded for general consistency of presentation and answer format was administered to a cross-continent sample from which 1003 complete data sets were obtained. Factoring of 401 variables was carried out by principal axis method followed by four rotation procedures: two orthogonal, two oblique. Results across the various solutions indicated the following factors: Sociability (SY), Adjustment-Emotionality (AE), Dominance (AD), Superego (SG), Hypochondriac-Medical (HM), Impulsiveness (IP), Cooperativeness-Considerateness (CC), Inferiority (IF), Persistence (PS), Trust vs. Suspicion (TS), General Activity (GA). In addition, other factors were found, which although of lesser variance, have been reported in the literature.

Personality characteristics of volunteers

374 female volunteers' responses to a questionnaire suggested study of conscience, altruism, and behavior is feasible.

A Psychometric Investigation of Eysenck's Personality Inventory

Eysenck's personality inventory (EPI) was administered to 653 females and 666 males. Item analyses were carried out for the subsamples and the combined sample. In addition hierarchical oblique factor analysis was applied to the data. The purpose of both item and factor analysis was to examine the psychometric properties of the EPI in regard to (a) the homogeneity of the scales, in terms both of internal and external item-scale relationships (b) the univocality of the scales assessed in factor analytic terms. It was found that the neuroticism scale was superior to the extraversion scale in both these respects.

A FACTOR ANALYSIS OF SELECTED MARKERS FOR OBJECTIVE PERSONALITY FACTORS

A large scale (60 variables, 569 subjects), attempted replication of Cattell's factors U.I. 16, 17, 19, 20, 21, 23, 24, 32 is reported, plus an evaluation of his universal index series. Factoring was carried out on marker variables, with both orthogonal and oblique rotation, at both primary and sec- ondary factor levels. Seven factors were identifiable a t the primary level and four at the secondary level. At neither level were the factors other than partly similar, and then only in certain cases, to Cattell's factors. An examination of Cattell's data both in general and in a specific case and a discussion of necessary criteria to assess replication show why this might occur. Contrary to prior kpectation what actually emerged from this group of carefully selected Cattell markers were factors which more closely resembled those of Eysenck, especially at the second order level.

Note on the role of neuroticism and extraversion in the "nice personality" stereotype

Compared with results obtained under standard directions, instructions to fake a “nice personality” on the Eysenck Personality Inventory produced a significant decrease in Neuroticism scores and significant increases in Extraversion and Lie scores in 70 adults. Similarity was noted between Eysenck's questionnaire factors of Neuroticism and Extraversion and Howarth's commonsense personality dimensions, emotional adjustment and social ability.

FACTOR ANALYSIS OF EMOTIONALITY IN TEN INBRED STRAINS OF MICE

One hundred and nineteen mice of 10 inbred strains were run on 32 measures from 16 tests in order to obtain a large variance coverage of behavioral differences for the purpose of obtaining factors among emotionality measures and strain factor scores.

Extraversion and increased interference in paired-associated learning

A previous study had shown that extraverts were superior in serial learning under distraction by competing responses from previously learned material. The present study introduced an incremental interference technique applied to paired-associate learning and verified the previous finding that personality differences can systematically affect standard learning tasks. The learning performance of 11 extraverts, 11 controls and 11 introverts was compared on a task consisting of five pairings of a color and a short animal name, e.g., Black-pig. After S had mastered the first series, the animal names were differently assigned among the colors so S had to learn in the face of competing responses. Finally, the pairings were changed in a third series, at which time the extraverts significantly outperformed (trials to criterion) the introverts, control Ss occupying an intermediate position.

Personality differences in serial learning under distraction

Previous work by Shanmugan had indicated that extraverts were able to perform better than introverts while under distraction. This experiment used serial learning of number groups, with a previously learned list of number pairs as a distractor in the final part of the experiment. It was found that greater percentage savings were obtained by extraverts under these conditions. In a third group of Ss initial distraction was arranged by placing a number pair in a group of four numbers. Extraverts also learned faster under these conditions. Several explanations of the present data are possible: (1) Jensen proposed that extraverts are more resistent to response competition, (2) Eysenck suggested that arousal, and hence, consolidation processes are less marked and intertere less in short-term memory in extraverts, (3) differences in strength of initial registration in very short-term memory may underlie the effect.

Expectations concerning occupations in relation to extraversion-introversion

132 Ss were asked to list occupations which would possess or make use of the personality descriptions of ‘extravert’ and ‘introvert’ as described in the manual of the Eysenck Personality Inventory. of 4000, those occurring more frequently than 2% of the column total (E or I) are shown. The criterion for allocation appears to revolve around the ‘person contact’ concept of extraversion.

The effect of grip-tension on tactile-kinaesthetic judgement of width

The effect of various grip-tensions on the accuracy of kinaesthetic width judgements was tested. Forty first-year psychology students were used as subjects. Significant differences in accuracy between pressures were found in the descending adjustments with greatest accuracy at 1.0 kg. Some significant differences were found between pressures in ascending adjustments. All subjects overestimated on the descending and underestimated on the ascending trials at all pressure levels. Increased grip-tension was found to reduce the accuracy of width judgement in terms of constant error while affecting varlance only slightly.

Headache, personality and stress

The observations recorded in this paper were made on 72 patients referred to a neurological clinic on account of headache who proved to have no evidence of organic disease and whose symptoms were not migrainous in nature. They were, therefore, suffering from the type of headache described as psychogenic headache, tension headache, stress headache, or common headache.

A test of Hull's reactive inhibition concept: persistence of curvilinear response pattern in button-pressing

Fifteen Ss were tested on a simple five-button linear display in order to (a) verify a bowing effect observed in a previous study and (b) test whether the bowing was reduced in repeated trials. According to a prediction based on Hull's concept of reactive inhibition, the more frequent responses in the pattern should have become less frequent and the initial curve less bowed. This did not occur; in fact, an exactly opposite result was obtained.