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Porter A, Franklin M, De Vocht F, d'Apice K, Curtin E, Albers P, Kidger J. Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation. BMJ Open 2024; 14:e077220. [PMID: 38296286 PMCID: PMC10828880 DOI: 10.1136/bmjopen-2023-077220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health. OBJECTIVES To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links. DESIGN A real-world evaluation using IAPT's electronic health records. SETTING Three National Health Service IAPT services in England. PARTICIPANTS Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline. INTERVENTION We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control). PRIMARY OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models. RESULTS Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control. CONCLUSIONS Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Franklin
- Health Economic and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frank De Vocht
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (NIHR ARC West), Bristol, UK
| | - Katrina d'Apice
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther Curtin
- Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Patricia Albers
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
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Curtin EL, Widnall E, Dodd S, Limmer M, Simmonds R, Russell AE, Kaley A, Kidger J. Exploring mechanisms and contexts in a Peer Education Project to improve mental health literacy in schools in England: a qualitative realist evaluation. Health Educ Res 2024; 39:40-54. [PMID: 37490030 PMCID: PMC10805377 DOI: 10.1093/her/cyad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023]
Abstract
Poor adolescent mental health calls for universal prevention. The Mental Health Foundation's 'Peer Education Project' equips older students ('peer educators') to teach younger students ('peer learners') about mental health. The peer-led lessons cover defining good and bad mental health, risk and protective factors, self-care, help-seeking and looking after one another. While previous pre-post evaluations have suggested effectiveness, the mechanisms through which the intervention improves mental health literacy remain unclear. We purposively recruited seven secondary schools across England from 2020 to 2022 and collected data through five observations, 12 staff interviews and 15 student focus groups (totalling 134 students; 46 peer educators aged 14-18 years and 88 peer learners aged 11-13 years). Our realist analysis adopted retroductive logic, intertwining deductive and inductive approaches to test the initial programme theory against insights arising from the data. We developed Context-Mechanisms-Outcome configurations related to four themes: (i) modelling behaviours and forming supportive relationships, (ii) relevant and appropriate content, (iii) peer educators feeling empowered and (iV) a school culture that prioritises mental health support. Our refined programme theory highlights key mechanisms, contexts conducive to achieving the outcomes and ways to improve training, recruitment and delivery to maximise effectiveness for similar peer-led initiatives.
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Affiliation(s)
- E L Curtin
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - E Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK
| | - S Dodd
- Division of Health Research, Lancaster University, Hazelrigg Lane, Lancaster LA1 4YW, UK
| | - M Limmer
- Division of Health Research, Lancaster University, Hazelrigg Lane, Lancaster LA1 4YW, UK
| | - R Simmonds
- Mental Health Foundation, Long Lane, London SE1 4PD, UK
| | - A E Russell
- College of Medicine and Health, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK
| | - A Kaley
- Division of Health Research, Lancaster University, Hazelrigg Lane, Lancaster LA1 4YW, UK
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - J Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol BS8 2PS, UK
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Pinfold V, Thompson R, Lewington A, Samuel G, Jayacodi S, Jones O, Vadgama A, Crawford A, Fischer LE, Dykxhoorn J, Kidger J, Oliver EJ, Duncan F. Public perspectives on inequality and mental health: A peer research study. Health Expect 2023; 27:e13868. [PMID: 37786331 PMCID: PMC10768865 DOI: 10.1111/hex.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Associations between structural inequalities and health are well established. However, there is limited work examining this link in relation to mental health, or that centres public perspectives. This study explores people's experience and sense-making of inequality in their daily lives, with particular consideration of impacts on mental health. METHODS We conducted a peer research study. Participants had to live in one of two London Boroughs and have an interest in inequalities and mental health. Using social media, newsletters, local organisations and our peer researchers' contacts, we recruited 30 participants who took photos representing their experience of inequality and discussed them during semi-structured interviews. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified in this study: (1) inequalities are unjust, multilayered and intertwined with mental health. Accounts demonstrated a deep understanding of inequalities and their link to mental health outcomes, describing inequalities as 'suffering' and 'not good for anyone'. Financial, housing, immigration and healthcare problems exacerbated poor mental health, with racism, gender-based violence and job loss also contributing factors for both poor mental health and experiences of inequality; (2) inequalities exclude and have far-reaching mental health consequences, impacting personal sense of belonging and perceived societal value and (3) moving forwards-addressing long-standing inequality and poor public mental health necessitated coping and resilience strategies that are often unacknowledged and undervalued by support systems. CONCLUSION Lived experience expertise was central in this study, creating an innovative methodological approach. To improve public mental health, we must address the everyday, painful structural inequalities experienced by many as commonplace and unfair. New policies and strategies must be found that involve communities, redistributing resources and power, building on a collective knowledge base, to coproduce actions combatting inequalities and improving population mental health. PATIENT OR PUBLIC CONTRIBUTION This study was peer-led, designed and carried out by researchers who had experiences of poor mental health. Six authors of the paper worked as peer researchers on this study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Judi Kidger
- Population Health SciencesUniversity of BristolBristolUK
| | - Emily J. Oliver
- Population Health SciencesUniversity of NewcastleNewcastleUnited Kingdom
| | - Fiona Duncan
- Population Health SciencesUniversity of NewcastleNewcastleUnited Kingdom
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Hatch LM, Widnall EC, Albers PN, Hopkins GL, Kidger J, de Vocht F, Kaner E, van Sluijs EMF, Fairbrother H, Jago R, Campbell RM. Conducting school-based health surveys with secondary schools in England: advice and recommendations from school staff, local authority professionals, and wider key stakeholders, a qualitative study. BMC Med Res Methodol 2023; 23:142. [PMID: 37322415 PMCID: PMC10273669 DOI: 10.1186/s12874-023-01957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Improving the health and well-being of young people is a public health priority. Schools present an ideal setting to implement strategies to improve young people's health and well-being. A key strategy involves conducting surveys to assess student health needs, inform interventions, and monitor health over time. Conducting research in schools is, however, challenging. Schools can find it difficult to participate and adhere to research processes, even when they are keen to be involved in research, because of competing priorities (e.g., attendance and educational achievement), as well as time and resource constraints. There is a lack of literature on the perspectives of school staff and other key stakeholders working in young people's health on how best to work with schools to conduct health research, and in particular, health surveys. METHODS Participants (n = 26) included members of staff from 11 secondary schools (covering students aged 11-16 years), 5 local authority professionals, and 10 wider key stakeholders in young people's health and well-being (e.g., a school governor, a national government member), based in South West England. Participants took part in semi-structured interviews that were conducted either over the phone or via an online platform. Data were analysed using the Framework Method. RESULTS Three main themes were identified: Recruitment and Retention, Practicalities of Data Collection in Schools, and Collaboration from Design to Dissemination. It is important to acknowledge the role of local authorities and academy trusts in the English education system, and work closely with these when conducting school-based health surveys. School staff prefer to be contacted about research via email and in the summer term, following exams. Researchers should contact a member of staff involved in student health/well-being, as well as senior leadership, during recruitment. Data collection during the start and end of the school year is undesirable. Research should be collaborative with school staff and young people, consistent with school priorities and values, and flexible and tailored to school timetables and resources. CONCLUSIONS Overall the findings demonstrate that survey-based research methods should be school-led and tailored to each school.
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Affiliation(s)
- Lorna M Hatch
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK.
| | - Emily C Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Patricia N Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Georgina L Hopkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
| | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Rona M Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
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Curtin EL, d'Apice K, Porter A, Widnall E, Franklin M, de Vocht F, Kidger J. Perspectives on an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a qualitative study. BMC Health Serv Res 2023; 23:536. [PMID: 37226155 DOI: 10.1186/s12913-023-09405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/14/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders' experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. METHODS Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. RESULTS Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. LIMITATIONS Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants' experiences of the service did suggest variation in our sample. CONCLUSIONS The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users' expectations, and improve accessibility for certain groups.
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Affiliation(s)
- Esther Louise Curtin
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Katrina d'Apice
- Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Alice Porter
- Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Emily Widnall
- Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Matthew Franklin
- School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK
| | - Frank de Vocht
- Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- NIHR Applied Research Collaboration West (NIHR ARC West), Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK
| | - Judi Kidger
- Centre for Public Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Widnall E, Albers PN, Hatch L, Hopkins G, Kidger J, Vocht FD, Kaner E, Sluijs EMV, Fairbrother H, Jago R, Campbell R. Using systems thinking to understand how the South West - School Health Research Network can improve adolescent health and well-being: A qualitative process evaluation. Health Place 2023; 82:103034. [PMID: 37120949 PMCID: PMC7614868 DOI: 10.1016/j.healthplace.2023.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
Schools offer a valuable setting to promote good health and mental well-being amongst young people. Schools are complex systems and therefore systems interventions are needed to improve pupil health and well-being. This paper presents a qualitative process evaluation of the South West- School Health Research Network, a systems level intervention. The evaluation is based on interviews with school staff, local authorities and wider stakeholders. Given the complexity of England's educational system there is a need to intervene and monitor health at multiple levels and to ensure close partnership working to effectively improve adolescent health through schools.
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Affiliation(s)
- Emily Widnall
- Population Health Sciences, University of Bristol, UK.
| | | | - Lorna Hatch
- Population Health Sciences, University of Bristol, UK
| | | | - Judi Kidger
- Population Health Sciences, University of Bristol, UK
| | | | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, UK
| | | | | | - Russell Jago
- Population Health Sciences, University of Bristol, UK; Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, UK
| | - Rona Campbell
- Population Health Sciences, University of Bristol, UK
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7
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Widnall E, Hatch L, Albers PN, Hopkins G, Kidger J, de Vocht F, Kaner E, van Sluijs EM, Fairbrother H, Jago R, Campbell R. Implementing a regional school health research network in england to improve adolescent health and well-being, a qualitative process evaluation. BMC Public Health 2023; 23:745. [PMID: 37088825 PMCID: PMC10122722 DOI: 10.1186/s12889-023-15713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/19/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND There is an increased need for prevention and early intervention surrounding young people's health and well-being. Schools offer a pivotal setting for this with evidence suggesting that focusing on health within schools improves educational attainment. One promising approach is the creation of School Health Research Networks which exist in Wales and Scotland, but are yet to be developed and evaluated in England. METHODS This qualitative process evaluation aimed to identify the main barriers and facilitators to implementing a pilot School Health Research Network in the South West of England (SW-SHRN). Semi-structured interviews were conducted with school staff, local authority members, and other key stakeholders. Interview data were analysed using the 7-stage framework analysis approach. RESULTS Four main themes were identified from the data: (1) 'Key barriers to SW-SHRN' (competing priorities of academic attainment and well-being, schools feeling overwhelmed with surveys and lack of school time and resource); (2) 'Key facilitators to SW-SHRN: providing evidence-based support to schools' (improved knowledge to facilitate change, feedback reports and benchmarking and data to inform interventions); (3) 'Effective dissemination of findings' (interpretation and implementation, embedding findings with existing evidence and policy, preferences for an online platform as well personalised communication and the importance of involving young people and families); and (4) 'Longer-term facilitators: ensuring sustainability' (keeping schools engaged, the use of repeat surveys to evaluate impact, informing school inspection frameworks and expanding reach of the network). CONCLUSION This study identifies several barriers to be addressed and facilitators to be enhanced in order to achieve successful implementation of School Health Research Networks in England which include providing a unique offering to schools that is not too burdensome, supporting schools to take meaningful action with their data and to work closely with existing organisations, services and providers to become meaningfully embedded in the system.
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Affiliation(s)
- Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England.
| | - Lorna Hatch
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
| | - Patricia N Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
| | - Georgina Hopkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
| | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England
| | | | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, England
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, England
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Linton MJ, Shields R, Biddle L, Kidger J. Notifying university students' emergency contacts in mental health emergencies: Multi-year analysis of student consent policy preferences. Prev Med 2023; 169:107438. [PMID: 36736463 DOI: 10.1016/j.ypmed.2023.107438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Information sharing is a frequently discussed yet divisive suicide prevention strategy in universities. This study aimed to investigate which students are most and least likely to opt-in to university permission to notify an emergency contact if there are serious concerns about their mental health. Routine cross-sectional data were obtained from 29,799 students in 2020 and 31,998 students in 2021 within a UK university. The proportion of students opting-in to a 'consent to contact policy' across years was summarised descriptively. Multiple logistic regression models examined the odds of students opting-in dependent on student characteristics (probable clinical depression, age, gender identity, sexuality, ethnicity, home/international student status, disability, study mode and level of study). Most students opted-in to the policy in 2020 (91.2%, n = 27,146) and 2021 (90.4%, n = 28,912). Probable clinical depression (OR = 0.63, 95% CI = 0.54 to 0.72) and gender identity different from sex (OR = 0.63, 95% CI = 0.44 to 0.90) had the strongest associations with not opting-in in 2020. Identifying as male, lesbian/gay/bisexual, Asian ethnicity, declaring a disability, and being a taught postgraduate student were also predictive of not opting-in. These results were replicated in the 2021 dataset. Some of the most vulnerable students appear least likely to opt-in. Insights are offered about potential gaps in universities' access to emergency contacts to prevent serious harm or loss of life. Further research is required into why the groups identified in this study are less likely to opt-in and what additional support they may require.
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Affiliation(s)
- Myles-Jay Linton
- Population Health Sciences, University of Bristol, Bristol, United Kingdom; School of Education, University of Bristol, Bristol, United Kingdom.
| | - Robin Shields
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Carlisle VR, Jessiman PE, Breheny K, Campbell R, Jago R, Leonard N, Robinson M, Strong S, Kidger J. A Mixed Methods, Quasi-Experimental Evaluation Exploring the Impact of a Secondary School Universal Free School Meals Intervention Pilot. Int J Environ Res Public Health 2023; 20:5216. [PMID: 36982124 PMCID: PMC10049258 DOI: 10.3390/ijerph20065216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Food insecurity amongst households with children is a growing concern globally. The impacts in children include poor mental health and reduced educational attainment. Providing universal free school meals is one potential way of addressing these impacts. This paper reports findings on the impact of a universal free school meals pilot in two English secondary schools. We adopted a mixed-methods, quasi-experimental design. The intervention schools were one mainstream school (n = 414) and one school for students with special educational needs (n = 105). Two other schools were used as comparators (n = 619; n = 117). The data collection comprised a cross sectional student survey during the pilot (n = 404); qualitative interviews with students (n = 28), parents (n = 20) and school staff (n = 12); and student observations of lunchtimes (n = 57). Qualitative data were analysed using thematic analysis, and descriptive analyses and logistic regressions were conducted on the quantitative data. Self-reports of food insecurity were high at both intervention (26.6%) and comparator schools (25.8%). No effects of the intervention were seen in the quantitative findings on either hunger or food insecurity. Qualitative findings indicated that students, families and staff perceived positive impact on a range of outcomes including food insecurity, hunger, school performance, family stress and a reduction in stigma associated with means-tested free school meals. Our research provides promising evidence in support of universal free school meals in secondary schools as a strategy for addressing growing food insecurity. Future research should robustly test the impact of universal free school meals in a larger sample of secondary schools, using before and after measures as well as a comparator group.
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Affiliation(s)
- Victoria R. Carlisle
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Patricia E. Jessiman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Katie Breheny
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Rona Campbell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Russell Jago
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1QU, UK
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK
| | - Naomi Leonard
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | | | - Steve Strong
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Judi Kidger
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- NIHR PHIRST Insight, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
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Callway R, Le Gouais A, Bird EL, Chang M, Kidger J. Integrating Health into Local Plans: A Comparative Review of Health Requirements for Urban Development in Seven Local Planning Authorities in England. Int J Environ Res Public Health 2023; 20:4079. [PMID: 36901090 PMCID: PMC10002235 DOI: 10.3390/ijerph20054079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.
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Affiliation(s)
- Rosalie Callway
- Population Health Sciences, Bristol Medical School, University of Bristol, 1–5 Whiteladies Road, Bristol BS8 1NU, UK
| | - Anna Le Gouais
- Population Health Sciences, Bristol Medical School, University of Bristol, 1–5 Whiteladies Road, Bristol BS8 1NU, UK
| | - Emma L. Bird
- Centre for Public Health and Wellbeing, University of the West of England, Bristol BS16 1QY, UK
| | - Michael Chang
- Department of Civil Engineering, University of Bristol, Bristol BS8 1TL, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, 1–5 Whiteladies Road, Bristol BS8 1NU, UK
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Russell AE, Dunn B, Hayes R, Moore D, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T. Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study. BMJ Open 2023; 13:e065176. [PMID: 36787977 PMCID: PMC9930561 DOI: 10.1136/bmjopen-2022-065176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%-5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers' preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital 'toolkit' of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions. METHODS AND ANALYSIS A randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16-32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility. ETHICS AND DISSEMINATION Ethical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.
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Affiliation(s)
- Abigail Emma Russell
- Children and Young People's Mental Health Research Collaboration (ChYMe), University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Barney Dunn
- Department of Psychology, University of Exeter, Exeter, Devon, UK
| | - Rachel Hayes
- Children and Young People's Mental Health Research Collaboration (ChYMe), University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, Devon, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edmund Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Pfiffner
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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12
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Jessiman PE, Carlisle VR, Breheny K, Campbell R, Jago R, Robinson M, Strong S, Kidger J. A qualitative process evaluation of universal free school meal provision in two London secondary schools. BMC Public Health 2023; 23:300. [PMID: 36759797 PMCID: PMC9910769 DOI: 10.1186/s12889-023-15082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In the UK, one in five households with children experienced food insecurity in 2022, defined as a household-level economic and social condition of limited or uncertain access to adequate food. Free school meals are a public health intervention aimed at reducing food insecurity amongst children. The provision of universal free school meals (UFSM) to secondary school-aged children is a novel and untested intervention in the UK. This study is a process evaluation of a pilot of UFSM in two secondary schools in England. The aim was to understand the feasibility, acceptability, cost implications and lessons for the implementation of UFSM. METHODS 20 parents, 28 students and 8 school staff from two intervention schools participated in online qualitative interviews, as well as 4 staff from non-intervention schools. The Framework Method of thematic analysis was applied. These data were supplemented with student-led observations of school meal times, and school lunch uptake-data and cost information provided by the local authority delivering the pilot. RESULTS UFSM in secondary schools is a feasible and acceptable intervention, with coherent goals of increased access to a healthy meal, reduced food insecurity and better nutrition. All participants perceived these goals were met. Acceptability was further enhanced by the perception that UFSM were supporting a greater proportion of low-income families than the national, targeted Free School Meal scheme, as well as being easier to implement. Potential barriers to implementation include limited school kitchen and dining infrastructure, meal quality and choice, and increased queuing times. Participants' concerns that UFSM may benefit middle- and high- income families not in need were not as prevalent as the perception that UFSM was an effective way to support all families with secondary-aged children experiencing food insecurity. CONCLUSION This small-scale pilot study suggests that UFSM in secondary schools is feasible and acceptable, but more evidence is required from larger studies on the impact on long-term health, psychosocial and educational outcomes. Future, larger studies should also include detailed economic evaluations so this approach can be compared with other possible interventions.
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Affiliation(s)
- Patricia E. Jessiman
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Victoria R. Carlisle
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rona Campbell
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Russell Jago
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK ,grid.410421.20000 0004 0380 7336Applied Research Collaboration West (NIHR ARC West), The National Institute for Health Research, University Hospitals Bristol and Weston NHS Foundation Trust, BS1 2NT Bristol, UK
| | | | - Steve Strong
- Public co-applicant, PHIRST Insight, Hampshire, UK
| | - Judi Kidger
- grid.5337.20000 0004 1936 7603Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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13
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Dodd S, Widnall E, Russell AE, Curtin EL, Simmonds R, Limmer M, Kidger J. School-based peer education interventions to improve health: a global systematic review of effectiveness. BMC Public Health 2022; 22:2247. [PMID: 36461024 PMCID: PMC9719233 DOI: 10.1186/s12889-022-14688-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Peer education, whereby peers ('peer educators') teach their other peers ('peer learners') about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. METHODS Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11-18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. RESULTS A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention (n = 23), promoting healthy lifestyles (n = 17) and alcohol, smoking and substance use (n = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study quality varied greatly with many studies rated as poor quality, mainly due to unrepresentative samples and incomplete data. DISCUSSION School-based peer education interventions are implemented worldwide and span a wide range of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to quantitatively synthesise the evidence and make more confident conclusions, there is a need for more robust, high-quality evaluations of peer-led interventions using standardised health knowledge and behaviour measures.
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Affiliation(s)
- Steven Dodd
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Emily Widnall
- Population Health Sciences, University of Bristol, Bristol, UK.
| | | | - Esther Louise Curtin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mark Limmer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
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Curtin EL, Widnall E, Dodd S, Limmer M, Simmonds R, Russell AE, Kidger J. The Peer Education Project to improve mental health literacy in secondary school students in England: a qualitative realist evaluation. Lancet 2022; 400 Suppl 1:S34. [PMID: 36929978 PMCID: PMC9691050 DOI: 10.1016/s0140-6736(22)02244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Worsening of adolescent mental health and exacerbated health inequalities after the COVID-19 pandemic calls for universal preventative strategies. The Mental Health Foundation's school-based Peer Education Project seeks to improve students' mental health literacy through peer educators (aged 14-18 years) teaching peer learners (aged 11-13 years) to recognise good and bad mental health, identify risk and protective factors, and seek help accordingly. Although previous before and after quantitative assessments have found the intervention to be effective, this realist evaluation aimed to qualitatively develop the theory of change, exploring how the mechanisms played out in different contexts to achieve the desired outcomes. METHODS Our initial programme theory was developed following expert stakeholder consultation and reviewing the literature. We divided mechanisms into resources and reasoning to explain how the intervention components (ie, resources), experienced within specific contexts, engendered responses in the participants (ie, reasoning), to produce observable outcomes. Data collected from six purposively recruited schools in England comprised staff interviews (n=11), student focus groups (n=15), and observations (n=5). Deductive and inductive analysis was undertaken, using NVivo-informed multiple causal statements represented as context-mechanism-outcome configurations (CMOcs), to test and refine the programme theory. FINDINGS We created several distinct CMOcs. For example, in learners accustomed to didactic teaching methods (context), conversing with educators having similar life experience (mechanism resource) endorsed and destigmatised help-seeking behaviour (mechanism reasoning) and facilitated a realisation that seeking help was appropriate and acceptable (outcome). Other mechanisms included the following: learners perceiving the information as tailored and relevant, educators feeling empowered, and a cultural shift percolating across the school. INTERPRETATION Our findings show how peer education can work to improve mental health literacy, which will inform changes to the intervention to maximise its effectiveness in different operational contexts. Future research could test our theory of change in a randomised controlled trial, and examine impacts on inequalities in a more diverse sample. FUNDING National Institute for Health and Care Research School for Public Health Research.
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Affiliation(s)
- Esther Louise Curtin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steve Dodd
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Mark Limmer
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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15
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Sharp CA, Widnall E, Albers PN, Willis K, Capner C, Kidger J, de Vocht F, Kaner E, van Sluijs EMF, Fairbrother H, Jago R, Campbell R. Creation of a Pilot School Health Research Network in an English Education Infrastructure to Improve Adolescent Health and Well-Being: A Study Protocol. Int J Environ Res Public Health 2022; 19:ijerph192013711. [PMID: 36294290 PMCID: PMC9603152 DOI: 10.3390/ijerph192013711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/01/2022] [Accepted: 10/20/2022] [Indexed: 05/09/2023]
Abstract
Schools play a significant role in promoting health and well-being and the reciprocal links between health and educational attainment are well-evidenced. Despite recognition of the beneficial impact of school-based health improvement programmes, significant barriers to improving health and well-being within schools remain. This study pilots a School Health Research Network in the South West of England (SW-SHRN), a systems-based health intervention bringing together schools, academic health researchers and public health and/or education teams in local authorities to share knowledge and expertise to improve the health and well-being of young people. A maximum of 20 secondary schools will be recruited to the pilot SW-SHRN. All students in Years 8 (age 12-13) and 10 (age 14-15) will be invited to complete a health and well-being questionnaire, generating a cohort of approximately 5000 adolescents. School environment questionnaires will also be completed with each school to build a regional picture of existing school health policies and programmes. Each school will be provided with a report summarising data for their students benchmarked against data for all schools in the network. Quantitative analysis will model associations between health risk behaviours and mental health outcomes and a qualitative process evaluation will explore the feasibility and sustainability of the network. This study will create adolescent health data to help provide schools and local authorities with timely and robust information on the health and well-being of their students and help them to identify areas in which public health interventions may be required. SW-SHRN will also help public health professionals focus their resources in the areas most at need.
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Affiliation(s)
- Catherine A. Sharp
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- Correspondence:
| | - Patricia N. Albers
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Kate Willis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Colin Capner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Eileen Kaner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | | | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- Centre for Exercise Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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16
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Winstone L, Mars B, Haworth CMA, Heron J, Kidger J. Adolescent social media user types and their mental health and well-being: Results from a longitudinal survey of 13-14-year-olds in the United Kingdom. JCPP Adv 2022; 2:e12071. [PMID: 37431459 PMCID: PMC10242896 DOI: 10.1002/jcv2.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2022] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND There is mixed evidence as to the effects of different types of social media use on mental health, but previous research has been platform-specific and has focused on an oversimplified distinction between active and passive use. This study aimed to identify different underlying subgroups of adolescent social media user based on their pattern of social media activities and test associations between user type and future mental health. METHODS Students from 19 schools (N = 2456) in south-west England completed an online survey measuring 13 social media activities and four psychosocial outcomes (past year self-harm, depression, anxiety and poor well-being) at age 13 years (October 2019) and repeated a year later (October 2020; aged 14 years). Latent class analysis using Mplus identified distinct classes of social media user and stability of these classes was examined using latent transition analysis. A bias-adjusted three-step model was used to test associations between class membership at baseline and mental health at follow-up. Analyses were adjusted for gender, ethnicity, sexual orientation, socioeconomic status, disability, social media screen-time and baseline mental health. RESULTS A four-class model of social media user at baseline was selected based on fit statistics and interpretability. User types were labelled High Communicators; Moderate Communicators; Broadcasters; and Minimal users. Users became more active over time. Broadcasters at age 13 had the poorest mental health outcomes at age 14, with mental health and well-being generally better among the High and Moderate Communicators. CONCLUSIONS Findings suggest that broadcasters-adolescents with high levels of content sharing in addition to messaging and browsing online-are most likely to be experiencing poor mental health a year later. Recommendations regarding social media use should expand to consider different user types, and mental health implications of their engagement with different online activities in addition to screen-time.
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Affiliation(s)
- Lizzy Winstone
- Population Health Sciences, Medical SchoolUniversity of BristolBristolUK
| | - Becky Mars
- Population Health Sciences, Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation TrustBristolUK
| | - Claire M. A. Haworth
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation TrustBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
- The Alan Turing Institute, British LibraryLondonUK
| | - Jon Heron
- Population Health Sciences, Medical SchoolUniversity of BristolBristolUK
| | - Judi Kidger
- Population Health Sciences, Medical SchoolUniversity of BristolBristolUK
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17
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Widnall E, Winstone L, Plackett R, Adams EA, Haworth CMA, Mars B, Kidger J. Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey. IJERPH 2022; 19:ijerph19116768. [PMID: 35682350 PMCID: PMC9180617 DOI: 10.3390/ijerph19116768] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023]
Abstract
School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being.
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Affiliation(s)
- Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (L.W.); (B.M.); (J.K.)
- Correspondence:
| | - Lizzy Winstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (L.W.); (B.M.); (J.K.)
| | - Ruth Plackett
- Division of Primary Care and Population Health, University College London, London NW3 2PF, UK;
| | - Emma A. Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK;
| | | | - Becky Mars
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (L.W.); (B.M.); (J.K.)
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (L.W.); (B.M.); (J.K.)
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18
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Abstract
BACKGROUND There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. METHODS Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. RESULTS Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60-4.78] and men (AOR 2.52, 95% CI 1.51-4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87-33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57-4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32-43) in women and 22% (95% CI 14-29) in men. CONCLUSIONS Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.
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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Lalith Senarathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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19
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Jessiman P, Kidger J, Spencer L, Geijer-Simpson E, Kaluzeviciute G, Burn AM, Leonard N, Limmer M. School culture and student mental health: a qualitative study in UK secondary schools. BMC Public Health 2022; 22:619. [PMID: 35351062 PMCID: PMC8964383 DOI: 10.1186/s12889-022-13034-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is consistency of evidence on the link between school culture and student health. A positive school culture has been associated with positive child and youth development, effective risk prevention and health promotion efforts, with extensive evidence for the impact on student mental health. Interventions which focus on socio-cultural elements of school life, and which involve students actively in the process, are increasingly understood to be important for student mental health promotion. This qualitative study was undertaken in three UK secondary schools prior to the implementation of a participative action research study bringing students and staff together to identify changes to school culture that might impact student mental health. The aim was to identify how school culture is conceptualised by students, parents and staff in three UK secondary schools. A secondary aim was to explore which components of school culture were perceived to be most important for student mental health. Methods Across three schools, 27 staff and seven parents participated in in-depth interviews, and 28 students participated in four focus groups. The Framework Method of thematic analysis was applied. Results Respondents identified elements of school culture that aligned into four dimensions; structure and context, organisational and academic, community, and safety and support. There was strong evidence of the interdependence of the four dimensions in shaping the culture of a school. Conclusions School staff who seek to shape and improve school culture as a means of promoting student mental health may have better results if this interdependence is acknowledged, and improvements are addressed across all four dimensions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13034-x.
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Affiliation(s)
- Patricia Jessiman
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
| | - Judi Kidger
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Liam Spencer
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Geijer-Simpson
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Kaluzeviciute
- School of Clinical Medicine, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anne-Marie Burn
- School of Clinical Medicine, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Naomi Leonard
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Limmer
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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20
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Evans R, Bell S, Brockman R, Campbell R, Copeland L, Fisher H, Ford T, Harding S, Powell J, Turner N, Kidger J. Wellbeing in Secondary Education (WISE) Study to Improve the Mental Health and Wellbeing of Teachers: A Complex System Approach to Understanding Intervention Acceptability. Prev Sci 2022; 23:922-933. [PMID: 35305231 PMCID: PMC9343291 DOI: 10.1007/s11121-022-01351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
Teaching staff report poorer mental health and wellbeing than the general working population. Intervention to address this issue is imperative, as poor wellbeing is associated with burnout, presenteeism, and adverse student mental health outcomes. The Wellbeing in Secondary Education (WISE) intervention is a secondary school-based programme aimed at improving the mental health and wellbeing of teachers and students. There are three components: awareness-raising for staff; a peer support service delivered by staff trained in Mental Health First Aid (MHFA); and Schools and Colleges Mental Health First Aid (MHFA) training for teachers. A cluster randomised controlled trial with integrated process and economic evaluation was conducted with 25 secondary schools in the UK (2016-2018). The intervention was largely ineffective in improving teacher mental health and wellbeing. This paper reports process evaluation data on acceptability to help understand this outcome. It adopts a complex systems perspective, exploring how acceptability is a dynamic and contextually contingent concept. Data sources were as follows: interviews with funders (n = 3); interviews with MHFA trainers (n = 6); focus groups with peer supporters (n = 8); interviews with headteachers (n = 12); and focus groups with teachers trained in Schools and Colleges MHFA (n = 7). Results indicated that WISE intervention components were largely acceptable. Initially, the school system was responsive, as it had reached a 'tipping point' and was prepared to address teacher mental health. However, as the intervention interacted with the complexities of the school context, acceptability became more ambiguous. The intervention was seen to be largely inadequate in addressing the structural determinants of teacher mental health and wellbeing (e.g. complex student and staff needs, workload, and system culture). Future teacher mental health interventions need to focus on coupling skills training and support with whole school elements that tackle the systemic drivers of the problem.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales.
| | - Sarah Bell
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rowan Brockman
- Bristol Medical School, University of Bristol, Bristol, England
| | - Rona Campbell
- Department of Population Health Sciences, University of Bristol, Bristol, England
| | - Lauren Copeland
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - Harriet Fisher
- Bristol Medical School, University of Bristol, Bristol, England
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, England
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, England
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, England
| | - Judi Kidger
- Bristol Medical School, University of Bristol, Bristol, England
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21
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Troy D, Anderson J, Jessiman PE, Albers PN, Williams JG, Sheard S, Geijer-Simpson E, Spencer L, Kaner E, Limmer M, Viner R, Kidger J. What is the impact of structural and cultural factors and interventions within educational settings on promoting positive mental health and preventing poor mental health: a systematic review. BMC Public Health 2022; 22:524. [PMID: 35300632 PMCID: PMC8927746 DOI: 10.1186/s12889-022-12894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Mental health (MH) difficulties are on the increase among children and young people (CYP). Evidence has shown that educational settings contain both risk and protective factors for MH. This review investigated which structural and cultural factors and interventions within educational settings promote positive MH and prevent poor MH in 4–18 year olds. Searches were conducted in PsychINFO, Embase, ERIC, ASSIA and British Education Index, and reference lists from key studies and relevant systematic reviews were hand-searched. Intervention, cohort, and qualitative studies were included. Of the 62 included papers, 36 examined cultural factors (30 social/relational and six value-related) while 12 studies examined structural factors (eight organisational and four physical) and 14 studies examined multiple factors. There was strong evidence for the impact of positive classroom management techniques, access to physical activity, and peer mentoring on student MH. Studies examining the impact of positive school culture, teacher training in MH and parent involvement in school MH activities also found predominantly positive results for student MH, albeit the evidence was of lower quality or from a low number of studies. Few studies explicitly examined the impact of interventions on MH inequalities; those that did indicated limited if any reduction to inequalities. A very small number of studies suggested that interventions targeting those at risk of poor MH due to socioeconomic factors could successfully improve wellbeing and reduce depression, anxiety and behavioural problems. Studies exploring the effect of management and leadership strategies within schools, policies, and aspects of the physical environment other than green space were scarce or absent in the literature. This review highlights the need to consider the ways in which educational settings are organised, the culture that is created and the physical space in order to improve the MH of CYP.
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Affiliation(s)
- David Troy
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK.
| | - Joanna Anderson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Patricia E Jessiman
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patricia N Albers
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna G Williams
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mark Limmer
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Russell Viner
- Population, Policy and Practice Department, University College London, London, UK
| | - Judi Kidger
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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22
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Russell AE, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T. Synthesising the existing evidence for non-pharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol. Syst Rev 2022; 11:28. [PMID: 35168685 PMCID: PMC8848797 DOI: 10.1186/s13643-022-01902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome. METHODS A systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components. DISCUSSION This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD. TRIAL REGISTRATION PROSPERO number CRD42021233924.
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Affiliation(s)
- Abigail E Russell
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Darren Moore
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Amy Sanders
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Barnaby Dunn
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Rachel Hayes
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | | | | | - Linda Pfiffner
- University of California San Francisco, San Francisco, USA
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23
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Linton MJ, Biddle L, Bennet J, Gunnell D, Purdy S, Kidger J. Barriers to students opting-in to universities notifying emergency contacts when serious mental health concerns emerge: A UK mixed methods analysis of policy preferences. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2021.100289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Kidger J, Evans R, Bell S, Fisher H, Turner N, Hollingworth W, Harding S, Powell J, Brockman R, Copeland L, Araya R, Campbell R, Ford T, Gunnell D, Morris R, Murphy S. Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT. Public Health Res 2021. [DOI: 10.3310/phr09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves.
Objective
To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training.
Design
A cluster randomised controlled trial with embedded process and economic evaluations.
Setting
Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016.
Participants
All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up).
Intervention
Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice.
Main outcome measures
The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models.
Economic evaluation
A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis.
Process evaluation
A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context.
Results
All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture.
Limitations
Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage.
Conclusions
The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life.
Future work
Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions.
Trial registration
Current Controlled Trials ISRCTN95909211.
Funding
This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.
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Affiliation(s)
- Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Sarah Bell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Harriet Fisher
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Unit, University of Bristol, Bristol, UK
| | | | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Rowan Brockman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ricardo Araya
- Centre for Population Neuroscience and Precision Medicine, King’s College London, London, UK
| | - Rona Campbell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Richard Morris
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
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25
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Kidger J, Turner N, Hollingworth W, Evans R, Bell S, Brockman R, Copeland L, Fisher H, Harding S, Powell J, Araya R, Campbell R, Ford T, Gunnell D, Murphy S, Morris R. An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): A cluster randomised controlled trial. PLoS Med 2021; 18:e1003847. [PMID: 34762673 PMCID: PMC8629387 DOI: 10.1371/journal.pmed.1003847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/29/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention. METHODS AND FINDINGS The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was £9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures. CONCLUSIONS In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being. TRIAL REGISTRATION www.isrctn.com ISRCTN95909211.
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Affiliation(s)
- Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Sarah Bell
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rowan Brockman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Lauren Copeland
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Harriet Fisher
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Sarah Harding
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Jillian Powell
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Ricardo Araya
- Centre for Population Neuroscience and Precision Medicine, King’s College London, London, United Kingdom
| | - Rona Campbell
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - David Gunnell
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Richard Morris
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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26
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Widnall E, Dodd S, Simmonds R, Bohan H, Russell A, Limmer M, Kidger J. A process evaluation of a peer education project to improve mental health literacy in secondary school students: study protocol. BMC Public Health 2021; 21:1879. [PMID: 34663288 PMCID: PMC8522854 DOI: 10.1186/s12889-021-11921-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional disorders in young people are increasing but studies have found that this age group do not always recognise the signs and symptoms of mental health problems in themselves or others. The Mental Health Foundation's school-based Peer Education Project (PEP) has the potential to improve young people's understanding of their own mental health at a critical developmental stage (early adolescence) using a peer teaching method. This study is a process evaluation to understand: the mechanisms through which PEP might improve young people's mental health literacy, any challenges with delivery, how the project can be embedded within wider school life and how it can be improved to be of most benefit to the widest number of young people. We will also validate a bespoke mental health literacy questionnaire, and test the feasibility of using it to measure outcomes in preparation for a future study evaluating effectiveness. METHODS All schools recruited to the study will receive the PEP intervention. The process evaluation will be informed by realist evaluation approaches to build understanding regarding key mechanisms of change and the impact of different school contexts. The evaluation will test and revise an existing intervention logic model which has been developed in partnership with the Mental Health Foundation. Process evaluation data will be collected from newly recruited schools (n = 4) as well as current PEP user schools (n = 2) including training and lesson delivery observations, staff interviews and student focus groups. Baseline and follow-up data will be collected in all newly recruited intervention schools (n = 4) from all students in Year 7/8 (who receive the PEP) and recruited peer educators in Year 12 via a self-report survey. DISCUSSION This study will enable us to refine the logic model underpinning the peer education project and identify areas of the intervention that can be improved. Findings will also inform the design of a future effectiveness study which will test out the extent to which PEP improves mental health literacy.
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Affiliation(s)
- Emily Widnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK.
| | | | | | | | - Abigail Russell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK.,College of Medicine & Health, University of Exeter, Exeter, UK
| | | | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PL, UK
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27
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Winstone L, Mars B, Haworth CMA, Kidger J. Social media use and social connectedness among adolescents in the United Kingdom: a qualitative exploration of displacement and stimulation. BMC Public Health 2021; 21:1736. [PMID: 34560872 PMCID: PMC8464110 DOI: 10.1186/s12889-021-11802-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Connectedness to family and peers is a key determinant of adolescent mental health. Existing research examining associations between social media use and social connectedness has been largely quantitative and has focused primarily on loneliness, or on specific aspects of peer relationships. In this qualitative study we use the displacement hypothesis and the stimulation hypothesis as competing theoretical lenses through which we examine the complex relationship between social media use and feelings of connectedness to family and peers. Methods In-depth paired and individual interviews were conducted with twenty-four 13–14-year-olds in two inner-city English secondary schools. Interviews were transcribed verbatim, coded and thematically analysed. Results Analysis identified four themes: (i) ‘Displacement of face-to-face socialising’ (ii) ‘Social obligations’ (iii) ‘(Mis)Trust’ and (iv) ‘Personal and group identity’. Results indicated stronger support for the stimulation hypothesis than the displacement hypothesis. We found evidence of a complex set of reciprocal and circular relationships between social media use and connectedness consistent with a ‘rich-get-richer’ and a ‘poor-get-poorer’ effect for family and peer connectedness – and a ‘poor-get-richer’ effect in peer connectedness for those who find face-to-face interactions difficult. Conclusion Our findings suggest that parents should take a measured approach to social media use, providing clear guidance, promoting trust and responsible time management, and acknowledging the role of social media in making connections. Understanding and sharing in online experiences is likely to promote social connectedness. Supporting young people to negotiate breathing space in online interactions and prioritising trust over availability in peer relationships may optimise the role of social media in promoting peer connectedness. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11802-9.
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Affiliation(s)
- Lizzy Winstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - Becky Mars
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.,NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS8 2BN, UK
| | - Claire M A Haworth
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS8 2BN, UK.,School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK.,The Alan Turing Institute, British Library, London, NW1 2DB, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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28
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Bandara P, Page A, Senarathna L, Kidger J, Feder G, Gunnell D, Rajapakse T, Knipe D. 713Domestic violence and self-poisoning in Sri Lanka. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is increasing evidence that domestic violence is an important risk factor for suicidal behaviour. The level of risk of domestic violence (DV) and its contribution to the overall burden of suicidal behaviour has not been quantified in South Asia, where 37% of suicide deaths globally occur. We examined the association between DV and self-poisoning in Sri Lanka through a large case-control study.
Methods
Multivariable logistic regression models were conducted on 298 self-poisoning cases and 500 hospital controls to estimate the association between domestic violence and self-poisoning, and population attributable fractions (PAF) were estimated. Sensitivity analyses were conducted using 455 population-based controls.
Results
DV exposure within the previous 12 months was strongly associated with self-poisoning for women (adjusted OR [AOR] 4·08, 95%CI 1·60-4·78) and men (AOR 2·52, 95%CI 1·51-4·21), compared to no abuse. Physical violence showed the highest risk among women, whereas among men, emotional abuse showed the highest risk (AOR 2·75, 95%CI 1·57-4·82). PAF% for exposure to at least one type of DV was 38% (95%CI 32-43) in women and 22% (95 CI 14-29) in men.
Conclusions
DV was strongly associated with suicidal behaviour for men and women. Almost 40% of female self-poisoning cases and a fifth of male cases may be reduced if domestic violence is addressed.
Key messages
The significant contribution of DV to the overall burden of self-poisoning suggests preventative and curative interventions to address domestic violence may yield significant gains in reducing suicidal behaviour in Sri Lanka, and other similar settings.
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Affiliation(s)
- Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Troy D, Russell A, Kidger J, Wright C. Childhood psychopathology mediates associations between childhood adversities and multiple health risk behaviours in adolescence: analysis using the ALSPAC birth cohort. J Child Psychol Psychiatry 2021; 62:1100-1109. [PMID: 33619761 PMCID: PMC8532527 DOI: 10.1111/jcpp.13379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood adversity strongly predicts adolescent multiple health risk behaviours (MRBs) such as alcohol/tobacco use, self-harm and physical inactivity, and both adversities and MRBs are associated with premature mortality and several chronic health conditions that are among the leading causes of death in adults. It is therefore important to understand the relationship between adversities and MRBs and what could mediate any association. The aim of this study was to explore whether childhood psychopathology mediates associations between adversities and MRBs. METHODS Participants were young people in the Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 5,799). Using structural equation modelling, we explored the associations between adversities before 9 years and MRBs at age 16 years. We also explored potential mediating pathways through dimensional psychopathology measured by the Strength and Difficulties Questionnaire subscales at age 12 years. RESULTS There were strong positive associations between adversities and MRBs (β .25, 95% CI 0.20, 0.31, p < .001) suggesting that each additional adversity is associated with a 0.25 increase in number of MRBs out of 13 total risk behaviours. We found robust evidence of mediating pathways from adversities through conduct problems (β .05, 95% CI 0.03, 0.06, p < .001), hyperactivity/inattention (β .02, 95% CI 0.01, 0.03, p < .001) and peer relationship problems (β -.02, 95% CI -0.03, -0.02, p < .001) to MRBs. CONCLUSIONS Increased conduct problems and hyperactivity/inattention appear to partially explain the relationship between adversities and MRBs. Peer relationship problems also appear to reduce the association between adversities and MRBs, and further research is needed to understand how to encourage peer connectivity without increasing risk of MRBs. These results suggest that interventions aimed at reducing MRBs among those exposed to childhood adversities could focus on prevention of behavioural problems.
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Affiliation(s)
- David Troy
- School of Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Abigail Russell
- Children and Young People's Mental Health Research CollaborationCollege of Medicine and HealthUniversity of ExeterExeterUK
| | - Judi Kidger
- School of Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Caroline Wright
- School of Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. Public Health Res 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
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. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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Rajapakse T, Russell AE, Kidger J, Bandara P, López-López JA, Senarathna L, Metcalfe C, Gunnell D, Knipe D. Correction: Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka. PLoS One 2021; 16:e0251223. [PMID: 33914846 PMCID: PMC8084171 DOI: 10.1371/journal.pone.0251223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Linton MJA, Jelbert S, Kidger J, Morris R, Biddle L, Hood B. Investigating the Use of Electronic Well-being Diaries Completed Within a Psychoeducation Program for University Students: Longitudinal Text Analysis Study. J Med Internet Res 2021; 23:e25279. [PMID: 33885373 PMCID: PMC8103302 DOI: 10.2196/25279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/21/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Psychoeducation has the potential to support students experiencing distress and help meet the demand for support; however, there is a need to understand how these programs are experienced. Web-based diaries are a useful activity for psychoeducation because of their therapeutic benefits, ability to capture naturalistic data relevant to well-being, and appropriateness for text analysis methods. Objective This study aims to examine how university students use electronic diaries within a psychoeducation program designed to enhance mental well-being. Methods The Science of Happiness course was administered to 154 undergraduate students in a university setting (the United Kingdom). Diaries were collected from the students for 9 weeks. Baseline well-being data were collected using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). The percentage of negative and positive emotion words used in diaries (emotional tone) and use of words from five life domains (social, work, money, health, and leisure) were calculated using the Linguistic Inquiry and Word Count 2015 software. Random effects (generalized least squares) regression models were estimated to examine whether time, diary characteristics, demographics, and baseline well-being predict the emotional tone of diaries. Results A total of 149 students participated in the diary study, producing 1124 individual diary entries. Compliance with the diary task peaked in week 1 (n=1041, 92.62%) and was at its lowest in week 3 (n=807, 71.81%). Compared with week 1, diaries were significantly more positive in their emotional tone during week 5 (mean difference 23.90, 95% CI 16.89-30.90) and week 6 (mean difference 26.62, 95% CI 19.35-33.88) when students were tasked with writing about gratitude and their strengths. Across weeks, moderate and high baseline SWEMWBS scores were associated with a higher percentage of positive emotion words used in diaries (increases compared with students scoring low in SWEMWBS were 5.03, 95% CI 0.08-9.98 and 7.48, 95% CI 1.84-13.12, respectively). At week 1, the diaries of students with the highest levels of baseline well-being (82.92, 95% CI 73.08-92.76) were more emotionally positive on average than the diaries of students with the lowest levels of baseline well-being (59.38, 95% CI 51.02-67.73). Diaries largely focused on the use of social words. The emotional tone of diary entries was positively related to the use of leisure (3.56, 95% CI 2.28-4.85) and social words (0.74, 95% CI 0.21-1.27), and inversely related to the use of health words (−1.96, 95% CI −3.70 to −0.22). Conclusions We found evidence for short-term task-specific spikes in the emotional positivity of web-based diary entries and recommend future studies examine the possibility of long-term impacts on the writing and well-being of students. With student well-being strategies in mind, universities should value and encourage leisure and social activities.
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Affiliation(s)
- Myles-Jay Anthony Linton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,School of Education, University of Bristol, Bristol, United Kingdom
| | - Sarah Jelbert
- School of Experimental Psychology, Bristol Cognitive Development Centre, University of Bristol, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Morris
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Bruce Hood
- School of Experimental Psychology, Bristol Cognitive Development Centre, University of Bristol, Bristol, United Kingdom
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33
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Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open 2021; 5:e000987. [PMID: 34192194 DOI: 10.1101/2020.10.25.20216937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To investigate student, parent/carer and secondary school staff attitudes towards school COVID-19 mitigation measures. METHODS Recruitment used school communication, community organisations and snowball sampling in South West England. Audio recorded online or phone individual/group semi-structured interviews were conducted in July-Septtember 2020 and lasted 30-60 min. Interviews focused on views towards social distancing, hand hygiene and testing. Framework analysis was performed on interview notes/transcripts. RESULTS Participants were 15 staff, 20 parents and 17 students (11-16 years) from 14 diverse schools. Concerns about COVID-19 risk at school, especially to vulnerable individuals, were outweighed by perceived risks of missed learning. Some staff felt guilt around being a potential 'spreader' by teaching multiple classes. Findings highlighted a wide variety of school COVID-19 mitigation measures being deployed due to ambiguous government guidance. Participants generally saw mitigation measures as an acceptable and pragmatic solution to the perceived impossibility of social distancing in crowded schools, although anticipated challenges changing habitual behaviour. Participants supported school COVID-19 testing but identified the need to consider data security and stigma around COVID-19 diagnosis. Staff were concerned about unintended consequences of risk-reduction strategies on student behaviour, learning and pastoral care, particularly for those with Special Educational Needs or mental health issues who may find the measures especially challenging, and resultant widening inequalities. CONCLUSION Families and staff supported COVID-19 mitigation measures in schools and would welcome the roll out school COVID-19 testing. Clear messaging and engendering collective responsibility are important for compliance and success of COVID-19 mitigation measures. However, schools and policy-makers should consider unintended consequences of measures, providing extra support for vulnerable students and those with additional needs, and consider ways to avoid widening educational and health inequalities. Findings demonstrate the acceptability of school COVID-19 infection control measures is likely to be influenced by the balance of risks and benefits to students.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Joanna May Kesten
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Rebecca Langford
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
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34
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Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open 2021; 5:e000987. [PMID: 34192194 PMCID: PMC7948157 DOI: 10.1136/bmjpo-2020-000987] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/09/2021] [Accepted: 01/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate student, parent/carer and secondary school staff attitudes towards school COVID-19 mitigation measures. Methods Recruitment used school communication, community organisations and snowball sampling in South West England. Audio recorded online or phone individual/group semi-structured interviews were conducted in July-Septtember 2020 and lasted 30-60 min. Interviews focused on views towards social distancing, hand hygiene and testing. Framework analysis was performed on interview notes/transcripts. Results Participants were 15 staff, 20 parents and 17 students (11-16 years) from 14 diverse schools. Concerns about COVID-19 risk at school, especially to vulnerable individuals, were outweighed by perceived risks of missed learning. Some staff felt guilt around being a potential 'spreader' by teaching multiple classes. Findings highlighted a wide variety of school COVID-19 mitigation measures being deployed due to ambiguous government guidance. Participants generally saw mitigation measures as an acceptable and pragmatic solution to the perceived impossibility of social distancing in crowded schools, although anticipated challenges changing habitual behaviour. Participants supported school COVID-19 testing but identified the need to consider data security and stigma around COVID-19 diagnosis. Staff were concerned about unintended consequences of risk-reduction strategies on student behaviour, learning and pastoral care, particularly for those with Special Educational Needs or mental health issues who may find the measures especially challenging, and resultant widening inequalities. Conclusion Families and staff supported COVID-19 mitigation measures in schools and would welcome the roll out school COVID-19 testing. Clear messaging and engendering collective responsibility are important for compliance and success of COVID-19 mitigation measures. However, schools and policy-makers should consider unintended consequences of measures, providing extra support for vulnerable students and those with additional needs, and consider ways to avoid widening educational and health inequalities. Findings demonstrate the acceptability of school COVID-19 infection control measures is likely to be influenced by the balance of risks and benefits to students.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Joanna May Kesten
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Rebecca Langford
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, Bristol, UK
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Rajapakse T, Russell AE, Kidger J, Bandara P, López-López JA, Senarathna L, Metcalfe C, Gunnell D, Knipe D. Childhood adversity and self-poisoning: A hospital case control study in Sri Lanka. PLoS One 2020; 15:e0242437. [PMID: 33211766 PMCID: PMC7676676 DOI: 10.1371/journal.pone.0242437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACE) have been recognized as an important risk factor for suicidal behaviour among adults, but evidence from low and middle-income countries is lacking. This study explored associations between ACE and hospital admission due to non-fatal self-poisoning in Sri Lanka. METHODS This was a case-control study. Adults admitted to a tertiary care hospital for medical management of self-poisoning were included as cases, and age and sex matched controls were recruited from the outpatient department. ACE were measured using the World Health Organization's Childhood Adversity Scale. Logistic regression models adjusting for age, sex, ethnicity, and religion were used to quantify the association between ACE and self-poisoning. RESULTS The study included 235 cases and 451 controls. Cases were 2.5 times (95% CI 1.8, 3.6) more likely to report an ACE than controls and had higher ACE scores. Childhood physical abuse (OR 4.7, 95% CI 1.2, 19.0) and emotional abuse or neglect (OR 3.7, 95% CI 1.3, 10.1, and 3.7, 95% CI 2.3, 6.0 respectively), increased the risk of self-poisoning in adulthood, as did witnessing household violence (OR 2.2, 95% CI 1.4, 3.4), growing up in a household with a mentally ill or suicidal household member (OR 2.1, 95% CI 1.2, 3.4), and experiencing parental death/separation/divorce (OR 3.1, 95% CI 2.0, 4.9) as a child. CONCLUSIONS Reducing exposures to ACEs should be a priority for prevention of suicide and self-harm in Sri Lanka. Innovative methods to increase support for children facing adversity should be explored.
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Affiliation(s)
- Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - José A. López-López
- Department of Basic Psychology & Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Lalith Senarathna
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihinthale, Sri Lanka
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Black D, Bates G, Gibson A, Hatleskog E, Fichera E, Hatchard J, Md Nazmul H, Rosenberg G, Larkin C, Brierley R, Kidger J, Bondy K, Hickman M, Pain K, Hicks B, Scally G, Verma A, Carhart N, Pilkington P, Hunt A, Ireland P. Pandemics, vulnerability, and prevention: time to fundamentally reassess how we value and communicate risk?: CITIES, HEALTH and COVID-19: Initial reflections and future challenges. Cities Health 2020; 5:S93-S96. [PMID: 38013679 PMCID: PMC10402659 DOI: 10.1080/23748834.2020.1811480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2023]
Abstract
For over a decade, pandemics have been on the UK National Risk Register as both the likeliest and most severe of threats. Non-infectious 'lifestyle' diseases were already crippling our healthcare services and our economy. COVID-19 has exposed two critical vulnerabilities: firstly, the UK's failure to adequately assess and communicate the severity of non-communicable disease; secondly, the health inequalities across our society, due not least to the poor quality of our urban environments. This suggests a potentially disastrous lack of preventative action and risk management more generally, notably with regards to the existential risks from the climate and ecological crises.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Charles Larkin
- University of Bath, Bath, UK
- Trinity College Dublin, Johns Hopkins University
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Fisher H, Harding S, Bell S, Copeland L, Evans R, Powell J, Araya R, Campbell R, Ford T, Gunnell D, Murphy S, Kidger J. Delivery of a Mental Health First Aid training package and staff peer support service in secondary schools: a process evaluation of uptake and fidelity of the WISE intervention. Trials 2020; 21:745. [PMID: 32847622 PMCID: PMC7448323 DOI: 10.1186/s13063-020-04682-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Improving children and young people's provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package delivered to at least 16% of staff, a short mental health awareness session to all teachers and development of a staff peer support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of uptake and fidelity of the intervention. METHODS Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. RESULTS In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the 2-day standard MHFA training course, and a further 146 (11.1%) staff completed the 1-day MHFA for schools and colleges training. In seven (58.3%) schools, the required 8% of staff completed the MHFA training packages. A 1-h mental health awareness-raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the 1-year follow-up, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. CONCLUSION The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools, insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach. TRIAL REGISTRATION ISRCTN 95909211 . Registered on 15 January 2016.
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Affiliation(s)
- Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sarah Harding
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sarah Bell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | | | - Rhiannon Evans
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Jillian Powell
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Ricardo Araya
- Health Service and Population Research Department, Kings College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tamsin Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Simon Murphy
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Mars B, Gunnell D, Biddle L, Kidger J, Moran P, Winstone L, Heron J. Prospective associations between internet use and poor mental health: A population-based study. PLoS One 2020; 15:e0235889. [PMID: 32701974 PMCID: PMC7377422 DOI: 10.1371/journal.pone.0235889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/22/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Most of the evidence on the effects of internet use on mental health derives from cross-sectional research. We set out to explore prospective associations between internet use (hours online and specific internet experiences) and future mental health problems. METHODS Participants were 1,431 respondents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, who completed a questionnaire on internet use (time online and ten different internet experiences) when they were aged 18 years. Outcomes included past year self-harm, assessed at 21 years and high levels of depression and anxiety symptoms, assessed at 22 years. Associations were investigated using logistic regression models and analyses were conducted separately for males and females. RESULTS Females reporting high levels of internet use (number of hours online) were found to be at increased risk of depression at follow-up (highest tertile vs lowest tertile OR = 1.41, 95% CI 0.90 to 2.20), whereas males with high levels of internet use were at increased risk for self-harm (highest tertile vs lowest tertile OR = 2.53, 95%CI 0.93 to 6.90). There was no evidence to suggest an association between hours spent online and anxiety. With regards to the specific internet experiences, associations were found for females but not for males. In fully adjusted models, being bullied online (OR = 1.76, 95% CI 1.09 to 2.86) and meeting someone face to face (OR = 1.55, 95% CI 1.00 to 2.41) were associated with an increased risk of future depression. Being bullied online was also associated with an increased risk of future self-harm (OR = 2.42, 95% CI 1.41 to 4.15), along with receiving unwanted sexual comments or material, and coming across pornography and violent/gruesome material. CONCLUSIONS Our findings highlight the importance of digital citizenship training to help teach young people to use technology safely and responsibly.
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Affiliation(s)
- Becky Mars
- Population Health Sciences University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - David Gunnell
- Population Health Sciences University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Lucy Biddle
- Population Health Sciences University of Bristol, Bristol, United Kingdom
| | - Judi Kidger
- Population Health Sciences University of Bristol, Bristol, United Kingdom
| | - Paul Moran
- Population Health Sciences University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Lizzy Winstone
- Population Health Sciences University of Bristol, Bristol, United Kingdom
| | - Jon Heron
- Population Health Sciences University of Bristol, Bristol, United Kingdom
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López-López JA, Kwong ASF, Washbrook E, Pearson RM, Tilling K, Fazel MS, Kidger J, Hammerton G. Trajectories of depressive symptoms and adult educational and employment outcomes. BJPsych Open 2019; 6:e6. [PMID: 31829293 PMCID: PMC7001468 DOI: 10.1192/bjo.2019.90] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depressive symptoms show different trajectories throughout childhood and adolescence that may have different consequences for adult outcomes. AIMS To examine trajectories of childhood depressive symptoms and their association with education and employment outcomes in early adulthood. METHOD We estimated latent trajectory classes from participants with repeated measures of self-reported depressive symptoms between 11 and 24 years of age and examined their association with two distal outcomes: university degree and those not in employment, education or training at age 24. RESULTS Our main analyses (n = 9399) yielded five heterogenous trajectories of depressive symptoms. The largest group found (70.5% of participants) had a stable trajectory of low depressive symptoms (stable-low). The other four groups had symptom profiles that reached full-threshold levels at different developmental stages and for different durations. We identified the following groups: childhood-limited (5.1% of participants) with full-threshold symptoms at ages 11-13; childhood-persistent (3.5%) with full-threshold symptoms at ages 13-24; adolescent onset (9.4%) with full-threshold symptoms at ages 17-19; and early-adult onset (11.6%) with full-threshold symptoms at ages 22-24. Relative to the majority 'stable-low' group, the other four groups all exhibited higher risks of one or both adult outcomes. CONCLUSIONS Accurate identification of depressive symptom trajectories requires data spanning the period from early adolescence to early adulthood. Consideration of changes in, as well as levels of, depressive symptoms could improve the targeting of preventative interventions in early-to-mid adolescence.
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Affiliation(s)
- José A. López-López
- Assistant Professor, Department of Basic Psychology and Methodology, University of Murcia, Spain; Honorary Research Fellow, Department of Population Health Sciences, Bristol Medical School; and Centre for Academic Mental Health, University of Bristol, UK
| | - Alex S. F. Kwong
- Student, School of Geographical Sciences, Centre for Multilevel Modelling and MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Elizabeth Washbrook
- Associate Professor in Quantitative Methods, Centre for Multilevel Modelling and School of Education, University of Bristol, UK
| | - Rebecca M. Pearson
- Lecturer in Psychiatric Epidemiology, Department of Population Health Sciences, Bristol Medical School; and Centre for Academic Mental Health, University of Bristol, UK
| | - Kate Tilling
- Professor of Medical Statistics, Department of Population Health Sciences, Bristol Medical School; and MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Mina S. Fazel
- Associate Professor, Department of Psychiatry, University of Oxford, UK
| | - Judi Kidger
- Lecturer in Public Health, Department of Population Health Sciences, Bristol Medical School; and Centre for Academic Mental Health, University of Bristol, UK
| | - Gemma Hammerton
- Senior Research Associate, Department of Population Health Sciences, Bristol Medical School; and Centre for Academic Mental Health, University of Bristol, UK
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Caldwell DM, Davies SR, Hetrick SE, Palmer JC, Caro P, López-López JA, Gunnell D, Kidger J, Thomas J, French C, Stockings E, Campbell R, Welton NJ. School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis. Lancet Psychiatry 2019; 6:1011-1020. [PMID: 31734106 PMCID: PMC7029281 DOI: 10.1016/s2215-0366(19)30403-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rates of anxiety and depression are increasing among children and young people. Recent policies have focused on primary prevention of mental disorders in children and young people, with schools at the forefront of implementation. There is limited information for the comparative effectiveness of the multiple interventions available. METHODS We did a systematic review and network meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for published and unpublished, passive and active-controlled randomised and quasi-randomised trials. We included educational setting-based, universal, or targeted interventions in which the primary aim was the prevention of anxiety and depression in children and young people aged 4-18 years. Primary outcomes were post-intervention self-report anxiety and depression, wellbeing, suicidal ideation, or self-harm. We assessed risk of bias following the Cochrane Handbook for Systematic Reviews of Interventions. We estimated standardised mean differences (SMD) using random effects network meta-analysis in a Bayesian framework. The study is registered with PROPSERO, number CRD42016048184. FINDINGS 1512 full-text articles were independently screened for inclusion by two reviewers, from which 137 studies of 56 620 participants were included. 20 studies were assessed as being at low risk of bias for both random sequence generation and allocation concealment. There was weak evidence to suggest that cognitive behavioural interventions might reduce anxiety in primary and secondary settings. In universal secondary settings, mindfulness and relaxation-based interventions showed a reduction in anxiety symptoms relative to usual curriculum (SMD -0·65, 95% credible interval -1·14 to -0·19). There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary settings. Comparison-adjusted funnel plots suggest the presence of small-study effects for the universal secondary anxiety analysis. Network meta-analysis was not feasible for wellbeing or suicidal ideation or self-harm outcomes, and results are reported narratively. INTERPRETATION Considering unclear risk of bias and probable small study effects for anxiety, we conclude there is little evidence that educational setting-based interventions focused solely on the prevention of depression or anxiety are effective. Future research could consider multilevel, systems-based interventions as an alternative to the downstream interventions considered here. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Departamento de Psicología Básica y Metodología, Facultad de Psicología, Universidad de Murcia, Spain
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
INTRODUCTION Childhood adversity (CA) has been suggested as a key risk factor for suicidal behaviour, but evidence from low/middle-income countries is lacking. In Sri Lanka, CA, in the form of child maltreatment or as a consequence of maternal separation, has been highlighted in primarily qualitative or case series work, as a potentially important determinant of suicidal behaviour. To date, there have been no quantitative studies to investigate CA as a key exposure associated with suicidal behaviour in Sri Lanka. The aim of the research is to understand the association between CA and suicidal behaviour in Sri Lanka and to identify potentially modifiable factors to reduce any observed increased risk of suicidal behaviour associated with CA. METHODS AND ANALYSIS This is a hospital-based case-control study. Cases (n=200) will be drawn from individuals admitted to the medical toxicology ward of the Teaching Hospital Peradeniya, Sri Lanka, for medical management of intentional self-poisoning. Sex and age frequency-matched controls (n=200) will be recruited from either patients or accompanying visitors presenting at the outpatient department and clinic of the same hospital for conditions unrelated to the outcome of interest. Conditional logistic regression will be used to investigate the association between CA and deliberate self-poisoning and whether the association is altered by other key factors including socioeconomic status, psychiatric morbidity, current experiences of domestic violence and social support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Ethical Review Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Researchers have been trained in administering the questionnaire and a participant safety and distress protocol has been designed to guide researchers in ensuring participant safety and how to deal with a distressed participant. Results will be disseminated in local policy fora and peer-reviewed articles, local media, and national and international conferences.
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Affiliation(s)
- Duleeka W Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Lalith Senarathna
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thilini Rajapakse
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Harding S, Morris R, Gunnell D, Ford T, Hollingworth W, Tilling K, Evans R, Bell S, Grey J, Brockman R, Campbell R, Araya R, Murphy S, Kidger J. Is teachers' mental health and wellbeing associated with students' mental health and wellbeing? J Affect Disord 2019; 242:180-187. [PMID: 30189355 DOI: 10.1016/j.jad.2018.08.080] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Factors within the school environment may impact young people's mental health and wellbeing. The aim of this study was to understand the association between teacher and student mental health and wellbeing. Further, it seeked to identify possible explanations by examining whether the strength of any association is weakened once quality of teacher-student relationships, teacher presenteeism and absence are considered. METHODS Cross-sectional data were collected from 3216 year 8 (aged 12-13 years) students and from 1182 teachers in 25 secondary schools in England and Wales. The association between teacher wellbeing (measured by Warwick Edinburgh Mental Wellbeing Scale (WEMWBS)) with student wellbeing (WEMWBS) and with student psychological distress (Total Difficulties Score (TDS)) was assessed using Random Effects Mixed Models. Analyses were repeated using teacher depression (measured by Patient Health Questionnaire) as the explanatory variable. RESULTS Better teacher wellbeing was associated with i) better student wellbeing (standardised effect = 0·07, 95% CI = 0·02 to 0·12) and ii) lower student psychological distress (standardised effect = -0·10, 95% CI = -0·16 to -0·04). Teacher presenteeism and the quality of the teacher-student relationship appeared to be on the pathway of these relationships. Higher levels of teacher depressive symptoms were associated with poorer student wellbeing and psychological distress (standardised effect = -0·06, 95% CI = -0·11 to -0·01 & 0·09, 95% CI = 0·03 to 0·15). This association did not withstand adjustment for teacher presenteeism. LIMITATIONS Cross sectional in design so unable to establish temporal associations. CONCLUSIONS Associations were found between teacher wellbeing and student wellbeing and psychological distress. There were also an association between teacher depression and student wellbeing. Both may be partially explained by teacher presenteeism and quality of teacher-student relationships.
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Affiliation(s)
- Sarah Harding
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England.
| | - Richard Morris
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK
| | - Sarah Bell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Jillian Grey
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK
| | - Rowan Brockman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
| | - Ricardo Araya
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, England
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Affiliation(s)
- David Gunnell
- Department of Population Health Sciences, University of Bristol, Bristol, UK
- National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Judi Kidger
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Taylor G, McMahon C, Reeves L, Hickman M. 'DrinkThink' alcohol screening and brief intervention for young people: a qualitative evaluation of training and implementation. J Public Health (Oxf) 2018; 40:381-388. [PMID: 28977388 PMCID: PMC6053838 DOI: 10.1093/pubmed/fdx090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background Alcohol Screening and Brief Intervention (ASBI) helps reduce risky drinking in adults, but less is known about its effectiveness with young people. This article explores implementation of DrinkThink, an ASBI co-produced with young people, by health, youth and social care professionals trained in its delivery. Methods A qualitative evaluation was conducted using focus groups with 33 staff trained to deliver DrinkThink, and eight interviews with trained participants and service managers. These were recorded, transcribed and a thematic analysis undertaken. Results DrinkThink was not delivered fully by health, youth or social care agencies. The reasons for this varied by setting but included: the training staff received, a working culture that was ill-suited to the intervention, staff attitudes towards alcohol which prioritized other health problems presented by young people, over alcohol use. Conclusions Implementation was limited because staff had not been involved in the design and planning of DrinkThink. Staffs’ perceptions of alcohol problems in young people and the diverse cultures in which they work were subsequently not accounted for in the design. Co-producing youth focused ASBIs with the professionals expected to deliver them, and the young people whom they target, may ensure greater success in integrating them into working practice.
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Affiliation(s)
- J Derges
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Kidger
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - F Fox
- University Hospital Bristol, NHS Foundation Trust, Bristol, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - E Kaner
- Institute of Health & Society, University of Newcastle, Newcastle upon Tyne, UK
| | - G Taylor
- Department for Health, University of Bath, Bath, UK
| | - C McMahon
- B&NES Council Public Health, Bath, UK
| | | | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Evans R, Brockman R, Grey J, Bell S, Harding S, Gunnell D, Campbell R, Murphy S, Ford T, Hollingworth W, Tilling K, Morris R, Kadir B, Araya R, Kidger J. A cluster randomised controlled trial of the Wellbeing in Secondary Education (WISE) Project - an intervention to improve the mental health support and training available to secondary school teachers: protocol for an integrated process evaluation. Trials 2018; 19:270. [PMID: 29728149 PMCID: PMC5936034 DOI: 10.1186/s13063-018-2617-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Secondary school teachers have low levels of wellbeing and high levels of depression compared with the general population. Teachers are in a key position to support students, but poor mental health may be a barrier to doing so effectively. The Wellbeing in Secondary Education (WISE) project is a cluster randomised controlled trial (RCT) of an intervention to improve the mental health support and training available to secondary school teachers through delivery of the training package Mental Health First Aid and a staff peer support service. We will conduct a process evaluation as part of the WISE trial to support the interpretation of trial outcomes and refine intervention theory. The domains assessed will be: the extent to which the hypothesised mechanisms of change are activated; system level influences on these mechanisms; programme differentiation and usual practice; intervention implementation, including any adaptations; intervention acceptability; and intervention sustainability. METHODS Research questions will be addressed via quantitative and qualitative methods. All study schools (n = 25) will provide process evaluation data, with more detailed focus group, interview and observation data being collected from a subsample of case study schools (4 intervention and 4 control). Mechanisms of change, as outlined in a logic model, will be measured via teacher and student surveys and focus groups. School context will be explored via audits of school practice that relate to mental health and wellbeing, combined with stakeholder interviews and focus groups. Implementation of the training and peer support service will be assessed via training observations, training participant evaluation forms, focus groups with participants, interviews with trainers and peer support service users, and peer supporter logs recording help provided. Acceptability and sustainability will be examined via interviews with funders, head teachers, trainers and peer support services users, and focus groups with training participants. DISCUSSION The process evaluation embedded within the WISE cluster RCT will illuminate how and why the intervention was effective, ineffective or conferred iatrogenic effects. It will contribute to the refinement of the theory underpinning the intervention, and will help to inform any future implementation. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN95909211 registered on 24 March 2016.
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Affiliation(s)
- Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Rowan Brockman
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jillian Grey
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Sarah Bell
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sarah Harding
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Gunnell
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Rona Campbell
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Tamsin Ford
- University of Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - William Hollingworth
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Kate Tilling
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Richard Morris
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Bryar Kadir
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London , David Goldberg Centre, De Crespigny Park, London, SE5 8AF UK
| | - Judi Kidger
- Bristol Medical School, Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Derges J, Kidger J, Fox F, Campbell R, Kaner E, Hickman M. Alcohol screening and brief interventions for adults and young people in health and community-based settings: a qualitative systematic literature review. BMC Public Health 2017; 17:562. [PMID: 28599632 PMCID: PMC5466741 DOI: 10.1186/s12889-017-4476-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews of alcohol screening and brief interventions (ASBI) highlight the challenges of implementation in healthcare and community-based settings. Fewer reviews have explored this through examination of qualitative literature and fewer still focus on interventions with younger people. METHODS This review aims to examine qualitative literature on the facilitators and barriers to implementation of ASBI both for adults and young people in healthcare and community-based settings. Searches using electronic data bases (Medline on Ovid SP, PsychInfo, CINAHL, Web of Science, and EMBASE), Google Scholar and citation searching were conducted, before analysis. RESULTS From a total of 239 papers searched and screened, 15 were included in the final review; these were selected based on richness of content and relevance to the review question. Implementation of ASBI is facilitated by increasing knowledge and skills with ongoing follow-up support, and clarity of the intervention. Barriers to implementation include attitudes towards alcohol use, lack of structural and organisational support, unclear role definition as to responsibility in addressing alcohol use, fears of damaging professional/ patient relationships, and competition with other pressing healthcare needs. CONCLUSIONS There remain significant barriers to implementation of ASBI among health and community-based professionals. Improving the way health service institutions respond to and co-ordinate alcohol services, including who is most appropriate to address alcohol use, would assist in better implementation of ASBI. Finally, a dearth of qualitative studies looking at alcohol intervention and implementation among young people was noted and suggests a need for further qualitative research.
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Affiliation(s)
- Jane Derges
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Judi Kidger
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Fiona Fox
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Rona Campbell
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Matthew Hickman
- University of Bristol School of Social and Community Medicine, Avon, Bristol, UK
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Kidger J, Evans R, Tilling K, Hollingworth W, Campbell R, Ford T, Murphy S, Araya R, Morris R, Kadir B, Moure Fernandez A, Bell S, Harding S, Brockman R, Grey J, Gunnell D. Protocol for a cluster randomised controlled trial of an intervention to improve the mental health support and training available to secondary school teachers - the WISE (Wellbeing in Secondary Education) study. BMC Public Health 2016; 16:1089. [PMID: 27756268 PMCID: PMC5070146 DOI: 10.1186/s12889-016-3756-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Teachers are reported to be at increased risk of common mental health disorders compared to other occupations. Failure to support teachers adequately may lead to serious long-term mental disorders, poor performance at work (presenteeism), sickness absence and health-related exit from the profession. It also jeopardises student mental health, as distressed staff struggle to develop supportive relationships with students, and such relationships are protective against student depression. A number of school-based trials have attempted to improve student mental health, but these have mostly focused on classroom based approaches and have failed to establish effectiveness. Only a few studies have introduced training for teachers in supporting students, and none to date have included a focus on improving teacher mental health. This paper sets out the protocol (version 4.4 20/07/16) for a study aiming to address this gap. METHODS Cluster randomised controlled trial with secondary schools as the unit of randomisation. Intervention schools will receive: i) Mental Health First Aid (MHFA) training for a group of staff nominated by their colleagues, after which they will set up a confidential peer support service for colleagues ii) training in MHFA for schools and colleges for a further group of teachers, which will equip them to more effectively support student mental health iii) a short mental health awareness raising session and promotion of the peer support service for all teachers. Comparison schools will continue with usual practice. The primary outcome is teacher wellbeing measured using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Secondary outcomes are teacher depression, absence and presenteeism, and student wellbeing, mental health difficulties, attendance and attainment. Measures will be taken at baseline, one year follow up (teachers only) and two year follow up. Economic and process evaluations will be embedded within the study. DISCUSSION This study will establish the effectiveness and cost-effectiveness of an intervention that supports secondary school teachers' wellbeing and mental health, and improves their skills in supporting students. It will also provide information regarding intervention implementation and sustainability. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN95909211 registered 24/03/16.
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Affiliation(s)
- Judi Kidger
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - William Hollingworth
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - Ricardo Araya
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Richard Morris
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Bryar Kadir
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Aida Moure Fernandez
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Sarah Bell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Sarah Harding
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Rowan Brockman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Jill Grey
- DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
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Kidger J, Stone T, Tilling K, Brockman R, Campbell R, Ford T, Hollingworth W, King M, Araya R, Gunnell D. A pilot cluster randomised controlled trial of a support and training intervention to improve the mental health of secondary school teachers and students - the WISE (Wellbeing in Secondary Education) study. BMC Public Health 2016; 16:1060. [PMID: 27716226 PMCID: PMC5053067 DOI: 10.1186/s12889-016-3737-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/30/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Secondary school teachers are at heightened risk of psychological distress, which can lead to poor work performance, poor quality teacher-student relationships and mental illness. A pilot cluster randomised controlled trial (RCT) - the WISE study - evaluated the feasibility of a full-scale RCT of an intervention to support school staff's own mental health, and train them in supporting student mental health. METHODS Six schools were randomised to an intervention or control group. In the intervention schools i) 8-9 staff received Mental Health First Aid (MHFA) training and became staff peer supporters, and ii) youth MHFA training was offered to the wider staff body. Control schools continued with usual practice. We used thematic qualitative data analysis and regression modelling to ascertain the feasibility, acceptability and potential usefulness of the intervention. RESULTS Thirteen training observations, 14 staff focus groups and 6 staff interviews were completed, and 438 staff (43.5 %) and 1,862 (56.3 %) students (years 8 and 9) completed questionnaires at baseline and one year later. MHFA training was considered relevant for schools, and trainees gained in knowledge, confidence in helping others, and awareness regarding their own mental health. Suggestions for reducing the length of the training and focusing on helping strategies were made. A peer support service was established in all intervention schools and was perceived to be helpful in supporting individuals in difficulty - for example through listening, and signposting to other services - and raising the profile of mental health at a whole school level. Barriers to use included lack of knowledge about the service, concerns about confidentiality and a preference for accessing support from pre-existing networks. CONCLUSIONS The WISE intervention is feasible and acceptable to schools. Results support the development of a full-scale cluster RCT, if steps are taken to improve response rates and implement the suggested improvements to the intervention. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN13255300 retrospectively registered 28/09/16.
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Affiliation(s)
- Judi Kidger
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Tracey Stone
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care in the West (NIHR CLAHRC West), 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Rowan Brockman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Tamsin Ford
- University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU UK
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
| | - Michael King
- Division of Psychiatry (Faculty of Brain Sciences), University College London, 6th Floor, Maple House, 149, Tottenham Court Road, London, W1T 7NF UK
| | - Ricardo Araya
- Ricardo Araya, Professor of Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39, Whatley Road, Bristol, BS8 2PS UK
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Kidger J, Brockman R, Tilling K, Campbell R, Ford T, Araya R, King M, Gunnell D. Teachers' wellbeing and depressive symptoms, and associated risk factors: A large cross sectional study in English secondary schools. J Affect Disord 2016; 192:76-82. [PMID: 26707351 DOI: 10.1016/j.jad.2015.11.054] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Teachers have been shown to have high levels of stress and common mental disorder, but few studies have examined which factors within the school environment are associated with poor teacher mental health. METHODS Teachers (n=555) in 8 schools completed self-report questionnaires. Levels of teacher wellbeing (Warwick Edinburgh Mental Wellbeing Scale-WEMWBS) and depressive symptoms (Patient Health Questionnaire-PHQ-9) were measured and associations between these measures and school-related factors were examined using multilevel multivariable regression models. RESULTS The mean (SD) teacher wellbeing score (47.2 (8.8)) was lower than reported in working population samples, and 19.4% had evidence of moderate to severe depressive symptoms (PHQ-9 scores >10). Feeling unable to talk to a colleague when feeling stressed or down, dissatisfaction with work and high presenteeism were all strongly associated with both poor wellbeing (beta coefficients ranged from -4.65 [-6.04, -3.28] to -3.39 [-5.48, -1.31]) and depressive symptoms (ORs ranged from 2.44 [1.41, 4.19] to 3.31 [1.70, 6.45]). Stress at work and recent change in school governance were also associated with poor wellbeing (beta coefficients=-4.22 [-5.95, -2.48] and -2.17 [-3.58, -0.77] respectively), while sickness absence and low student attendance were associated with depressive symptoms (ORs=2.14 [1.24, 3.67] and 1.93 [1.06, 6.45] respectively). LIMITATIONS i) This was a cross-sectional study; causal associations cannot be identified ii) several of the measures were self-report iii) the small number of schools reduced study power for the school-level variables CONCLUSIONS Wellbeing is low and depressive symptoms high amongst teachers. Interventions aimed at improving their mental health might focus on reducing work related stress, and increasing the support available to them.
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Mars B, Heron J, Crane C, Hawton K, Kidger J, Lewis G, Macleod J, Tilling K, Gunnell D. Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort. J Affect Disord 2014; 168:407-14. [PMID: 25108277 PMCID: PMC4160300 DOI: 10.1016/j.jad.2014.07.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/04/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. METHOD Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. RESULTS Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. LIMITATIONS i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. CONCLUSION Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm.
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Affiliation(s)
- Becky Mars
- School of Social and Community Medicine, University of Bristol, United Kingdom.
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Catherine Crane
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Judi Kidger
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Glyn Lewis
- Mental Health Sciences Unit, University College London, United Kingdom
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, United Kingdom
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