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Hards E, Hsu TC, Joshi G, Ellis J, Reynolds S. 'Who will I become?': possible selves and depression symptoms in adolescents - CORRIGENDUM. Behav Cogn Psychother 2024:1-2. [PMID: 38444244 DOI: 10.1017/s1352465824000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Loades ME, Midgley N, Herring GT, O'Keeffe S, Reynolds S, Goodyer IM. In Context: Lessons About Adolescent Unipolar Depression From the Improving Mood With Psychoanalytic and Cognitive Therapies Trial. J Am Acad Child Adolesc Psychiatry 2024; 63:122-135. [PMID: 37121393 DOI: 10.1016/j.jaac.2023.03.017] [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: 08/12/2022] [Revised: 02/19/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
This paper summarizes the results of the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) study and its implications for psychological treatment of adolescents with moderate to severe unipolar major depression. IMPACT was a pragmatic, superiority, randomized controlled trial conducted in the United Kingdom, which compared the clinical and cost-effectiveness of short-term psychoanalytic therapy (STPP), cognitive-behavioral therapy (CBT), and a brief psychosocial intervention (BPI) in reducing depression symptoms in 465 adolescents with unipolar major depression, aged 11 to 17 years. Although this was a clinically heterogeneous group of adolescents, some symptoms (eg, sleep and concentration difficulties, irritability/anger) were common and disabling. The trial reported no significant difference among the 3 treatments in reducing depression symptoms. One year after treatment, 84% of participants showed improvement in depressive symptoms (<50% of baseline symptoms) and improved psychosocial functioning, achieving this through different symptom reduction trajectories. Although participants attended fewer treatment sessions than planned, the 3 treatments were delivered with fidelity to their respective models. Ending treatment without therapist agreement occurred in 37% of cases. This was not associated with outcomes by treatment group. Adolescents emphasized the importance of the therapeutic relationship in all 3 treatments. Results suggest that although most adolescents respond to time-limited, structured psychological therapy, subgroups of depressed adolescents are likely to need additional treatment or support. These include adolescents who live in complex circumstances and/or who believe that their needs are not met in therapy, some who stop treatment early, and the 16% to 18% of adolescents who do not respond to treatment. CLINICAL TRIAL REGISTRATION INFORMATION: Improving Mood and Preventing Relapse With Psychoanalytic Psychotherapy and Cognitive Behaviour Therapy; https://www.isrctn.com; ISRCTN83033550.
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Affiliation(s)
| | - Nick Midgley
- University College London, United Kingdom and Anna Freud National Centre for Children and Families, London, United Kingdom.
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Hards E, Hsu TC, Joshi G, Ellis J, Reynolds S. 'Who will I become?': possible selves and depression symptoms in adolescents. Behav Cogn Psychother 2024:1-12. [PMID: 38284269 DOI: 10.1017/s1352465823000619] [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] [Indexed: 01/30/2024]
Abstract
BACKGROUND Adolescence is an important period for the development of the possible self. It is also a time when depression is prevalent. The cognitive theory of depression proposes that a negative view of the future is a key feature of depression. Targeting these negative thoughts about the future during cognitive behavioural therapy may be helpful in depression. However, little is known about how adolescents envisage their future (i.e. possible) self, or if the content is associated with affect. The aim of this quantitative study is to describe how adolescents describe their 'possible self' and examine the relationship between the valence of the possible self and depression in adolescents. METHOD Adolescents (n = 584) aged 13-18 years were recruited via opportunity sampling via their schools and completed measures of depression symptoms (the Mood and Feelings Questionnaire) and the 'possible self' (a variant of the 'I Will Be' task). Possible selves were coded for content and valence. RESULTS Despite depression severity, the most common possible selves generated by adolescents were positive and described interpersonal roles. The valence of the possible self was associated with depression severity but only accounted for 3.4% of the variance in severity. CONCLUSION The results support the cognitive model of depression. However, adolescents with elevated symptoms of depression were able to generate positive, possible selves and therefore may remain somewhat 'hopeful' about their future despite clinically significant depression symptoms. Future-oriented treatment approaches such as cognitive behavioural therapy that focus on changing unhelpful negative future thinking may not be appropriate for this population.
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Affiliation(s)
- Emily Hards
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Ting-Chen Hsu
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Gauri Joshi
- Department of Psychology, University of Bath, Claverton Down, Bath, UK
| | - Judi Ellis
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading, UK
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Hards E, Orchard F, Reynolds S. 'I am tired, sad and kind': self-evaluation and symptoms of depression in adolescents. Child Adolesc Psychiatry Ment Health 2023; 17:126. [PMID: 37941014 PMCID: PMC10633984 DOI: 10.1186/s13034-023-00661-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Although self-evaluation i.e., negative perceptions of the self is a common depression symptom in adolescents, little is known about how this population spontaneously describe their self and available data on adolescent self-evaluation is limited. This study aimed to generate and report on a list of words used by healthy adolescents and those with elevated depression symptoms to describe their self-evaluation. Linguistic analysis (LIWC) was then used to compare self-evaluation between the two groups. METHODS Adolescents aged 13-18 years (n = 549) completed a measure of depression symptoms (the Mood and Feelings Questionnaire) and a measure of self-evaluation (the Twenty Statements Test). Responses were then collated and presented in a freely accessible resource and coded using Linguistic Inquiry Word Count (LIWC) analysis. RESULTS Self-evaluation words generated by adolescents were uploaded to a publicly accessible site for future research: https://doi.org/10.15125/BATH-01234 . Adolescents with elevated depression symptoms described themselves as 'Tired' and 'Sad' more than healthy adolescents. However, there was no difference between groups in respect to their use of specific positive, prosocial self-evaluation 'words' (i.e., 'Caring' and 'Kind). Following Linguistic Inquiry Word Count (LIWC) analysis, adolescents with elevated depression symptoms generated significantly more words than healthy adolescents, generated more words classified as negative emotion, anxiety and sadness and generated fewer words classified positive emotion than healthy adolescents. CONCLUSIONS As predicted by the cognitive model of depression, our findings suggest that adolescents with elevated symptoms of depression generated more negative self-evaluation words than healthy adolescents; however they also generated prosocial positive self-evaluation words at the same rate as non-depressed adolescents. These novel data therefore identify an 'island' of resilience that could be targeted and amplified by psychological treatments for adolescent depression, and thus provide an additional technique of change.
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Affiliation(s)
- Emily Hards
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Faith Orchard
- School of Psychology, University of Sussex, Sussex, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Road, Reading, RG6 7BE, UK
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Binsaif S, Reynolds S, Jenkins P. Prevalence of depression symptoms among female adolescents in Saudi Arabia. J Child Adolesc Psychiatr Nurs 2023; 36:286-292. [PMID: 37221144 DOI: 10.1111/jcap.12429] [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: 03/10/2023] [Revised: 05/01/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Epidemiological studies on the prevalence of elevated depression symptoms among female adolescents in Saudi Arabia report a wide variation, ranging from 13.9% to 80.2%. However, different methods of assessment and sampling have been used. The aim of the current study is to estimate the prevalence of elevated depression symptoms amongst female adolescents in Saudi Arabia using a gold-standard self-report measure, the Mood and Feelings Questionnaire (MFQ). DESIGN AND MEASURES A cross-sectional study was conducted with 515 female students aged 13-18 years, recruited from public schools. Participants completed the Arabic versions of the MFQ, Rosenberg Self-Esteem Scale and Multidimensional Scale of Perceived Social Support. RESULTS Mean MFQ score for this sample was 26.35 and almost half of participants (48.2%) had scores above the cut-off. Severity of depression varied with age, with those aged 13 showing reduced symptoms, and was negatively correlated with self-esteem and perceived social support. There were no associations with other demographic factors. CONCLUSION Elevated levels of depression symptoms were common in this sample. This highlights the need to improve public mental health in this community and to improve methods of identifying and treating depression in female adolescents.
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Affiliation(s)
- Samr Binsaif
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Paul Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Pile V, Herring G, Bullard A, Loades M, Chan SWY, Reynolds S, Orchard F. A multi-stakeholders perspective on how to improve psychological treatments for depression in young people. Eur Child Adolesc Psychiatry 2023; 32:2375-2378. [PMID: 35543760 DOI: 10.1007/s00787-022-02001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/30/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | | | | | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK
| | - Stella W Y Chan
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Faith Orchard
- School of Psychology, University of Sussex, Falmer, BN1 9QH, East Sussex, UK.
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Supreeyaporn N, Watson R, Damrongpanit S, Orchard F, Reynolds S, Jenkins PE. Factor structure and measurement invariance of the Mood and Feelings Questionnaire: a cross-cultural study among Thai and British adolescents. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02268-8. [PMID: 37522960 DOI: 10.1007/s00787-023-02268-8] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
The Mood and Feelings Questionnaire-child self-report (MFQ-C) is a widely used measure of child and adolescent depression. This study evaluated possible factor solutions and examined the measurement invariance of the MFQ-C as a prerequisite for its use in cross-cultural comparisons between Thai (N = 1272) and British samples (N = 1817) by using multigroup confirmatory factor analysis (MGCFA). The latent means of Thai and British samples were also examined. A five-factor structure of the MFQ-C was confirmed through confirmatory factor analysis. A partial scalar invariant model was supported, and thus latent means were compared, with British adolescents reporting significantly higher mean MFQ-C scores than Thai adolescents on four of the five factors (Vegetative Symptoms, Suicidality, Cognitive Symptoms, Agitated Distress). There was no difference for the Core Symptoms factor. The findings also suggest that the MFQ-C is a valid measure to assess depression in Thai and British adolescents and maybe useful in cross-cultural comparisons of adolescent depression.
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Affiliation(s)
- Nanthaka Supreeyaporn
- Department of Educational Foundations and Development, Chiang Mai University, Chiang Mai, Thailand.
- Centre of Multiculturalism and Education Policy, Multidisciplinary Research Institute, Chiang Mai University, Chiang Mai, Thailand.
| | - Rebecca Watson
- Department of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Suntonrapot Damrongpanit
- Department of Educational Foundations and Development, Chiang Mai University, Chiang Mai, Thailand
| | - Faith Orchard
- School of Psychology, University of Sussex, Sussex, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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O'Donovan C, Samida S, Reynolds S, Miller P, Burrows S. 147 ESTABLISHING A PERI-OPERATIVE MEDICAL SERVICE (POMS) FOR OLDER PEOPLE IN UROLOGY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.124] [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: 11/14/2022] Open
Abstract
Abstract
Background
Older adults account for approximately 65% of patients undergoing urological procedures therefore as the population ages the demand is anticipated to rise. The benefits of Comprehensive Geriatric Assessment (CGA) have been proven in ortho-geriatrics and a number of surgical specialties but evidence in urology is lacking. The aim of this study was to assess the impact of a Peri-Operative Medical Service for older people (POMS) on patient outcomes in a urology inpatient population.
Methods
This was a single-centre retrospective study of patients ≥50 years with length of stay (LOS) >1 day admitted over two four month periods in 2018 (Pre-intervention) and 2019 (Intervention). Group differences in LOS and complications were examined using univariate regressions and then adjusted for sex, emergency admission, severity of procedure and Charlson Co-morbidity Index which also accounts for age. Secondary outcomes were to record undiagnosed medical conditions identified and the interventions made by the POMS.
Results
There were a total of 218 admissions from 211 patients with equal numbers of admissions in both the pre-intervention and intervention groups. No significant differences were detected for LOS (median 3 vs 4 days, p=0.11) or complications (32(29%) vs 40(37%), p=0.23) between pre-intervention and intervention groups. A new medical diagnosis was made in 13 (12%) of the pre-intervention v 43(39%) of the intervention group (p<0.001). The POMS recommended a change to management in 102 admissions (94%). The most common intervention was medication review: 64(59%) v 19(17%) (p<0.001).
Conclusion
The Peri-Operative Medical Service for older people can improve patient management by identifying and managing medical issues, complications and geriatric syndromes that may otherwise have been missed.
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Affiliation(s)
| | - S Samida
- Royal Perth Hospital , Perth, Australia
| | | | - P Miller
- Royal Perth Hospital , Perth, Australia
| | - S Burrows
- University of Western Australia School of Medicine, , Perth, Australia
- Royal Perth Hospital Research Foundation , Perth, Australia
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Keir M, Tarr C, McFadden C, Durupt G, Newman L, Sullivan J, Balon Y, Prieur T, Patton D, Jenkins J, Alvarez N, Colbert J, Guron N, Reynolds S, Myers K. DETERMINING RESEARCH PRIORITIES WITH TEEN AND ADULT CONGENITAL HEART DISEASE PATIENTS: A MIXED METHODS STUDY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Roberts H, Ford TJ, Karl A, Reynolds S, Limond J, Adlam ALR. Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model. Front Hum Neurosci 2022; 16:835897. [PMID: 35754774 PMCID: PMC9218558 DOI: 10.3389/fnhum.2022.835897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.
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Affiliation(s)
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anke Karl
- Psychology, University of Exeter, Exeter, United Kingdom
| | - Shirley Reynolds
- Department of Psychology, University of Reading, Reading, United Kingdom
| | - Jenny Limond
- Psychology, University of Exeter, Exeter, United Kingdom
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Hards E, Loades ME, Higson-Sweeney N, Shafran R, Serafimova T, Brigden A, Reynolds S, Crawley E, Chatburn E, Linney C, McManus M, Borwick C. Loneliness and mental health in children and adolescents with pre-existing mental health problems: A rapid systematic review. Br J Clin Psychol 2022; 61:313-334. [PMID: 34529837 DOI: 10.1111/bjc.12331] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 11/14/2020] [Revised: 07/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Periods of social isolation are associated with loneliness in children and young people, and loneliness is associated with poor mental and physical health. Children and young people with pre-existing mental health difficulties may be prone to loneliness. Containment of COVID-19 has necessitated widespread social isolation, with unprecedented school closures and restrictions imposed on social interactions. This rapid review aimed to establish what is known about the relationship between loneliness and mental health problems in children and young people with pre-existing mental health problems. METHODS We sought to identify all primary research that examined the cross-sectional and longitudinal associations between loneliness/perceived social isolation and mental health in children and young people with pre-existing mental health problems. We also aimed to identify effective interventions that reduce the adverse impact of loneliness. A rapid systematic search was conducted using MEDLINE, PsycINFO, and Web of Science. RESULTS Of 4,531 papers screened, 15 included children and young people with pre-existing mental health conditions. These 15 studies included 1,536 children and young people aged between 6 and 23 years with social phobia, anxiety and/or depression, and neurodevelopmental disorders. Loneliness was associated with anxiety and depression both cross-sectionally and prospectively in children and young people with mental health problems and neurodevelopmental conditions. We found preliminary evidence that psychological treatments can help to reduce feelings of loneliness in this population. CONCLUSIONS Loneliness is associated with depression and anxiety in children and young people with pre-existing mental health conditions, and this relationship may be bidirectional. Existing interventions to address loneliness and/or mental health difficulties in other contexts may be applied to this population, although they may need adaptation and testing in younger children and adolescents. PRACTITIONER POINTS Loneliness is common in children and young people, and during periods of enforced social isolation such as during COVID-19, children and young people report high levels of loneliness (or increased rates of loneliness). The review showed that loneliness is associated, both cross-sectionally and prospectively, in children and young people with mental health problems and also in children and young people with neurodevelopmental conditions, such as autism spectrum disorder. Thus, loneliness is a possible risk factor of which mental health providers should be aware. Maintaining social contact both by direct and by indirect means, especially through the Internet, could be important in mitigating loneliness. Interventions to address loneliness should be further developed and tested to help children and young people with pre-existing mental health problems who are lonely by preventing exacerbation of their mental health difficulties, in particular anxiety and depression.
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Affiliation(s)
- Emily Hards
- Department of Psychology, University of Bath, UK
| | - Maria Elizabeth Loades
- Department of Psychology, University of Bath, UK
- Centre for Academic Child Health, University of Bristol, UK
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Esther Crawley
- Centre for Academic Child Health, University of Bristol, UK
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Day F, Wyatt L, Bhardwaj A, Dubicka B, Ewart C, Gledhill J, James M, Lang A, Marshall T, Montgomery A, Reynolds S, Sprange K, Thomson L, Bradley E, Lathe J, Newman K, Partlett C, Starr K, Sayal K. STAndardised DIagnostic Assessment for children and young people with emotional difficulties (STADIA): protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e053043. [PMID: 35545388 PMCID: PMC9096530 DOI: 10.1136/bmjopen-2021-053043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Emotional disorders (such as anxiety and depression) are associated with considerable distress and impairment in day-to-day function for affected children and young people and for their families. Effective evidence-based interventions are available but require appropriate identification of difficulties to enable timely access to services. Standardised diagnostic assessment (SDA) tools may aid in the detection of emotional disorders, but there is limited evidence on the utility of SDA tools in routine care and equipoise among professionals about their clinical value. METHODS AND ANALYSIS A multicentre, two-arm, parallel group randomised controlled trial, with embedded qualitative and health economic components. Participants will be randomised in a 1:1 ratio to either the Development and Well-Being Assessment SDA tool as an adjunct to usual clinical care, or usual care only. A total of 1210 participants (children and young people referred to outpatient, specialist Child and Adolescent Mental Health Services with emotional difficulties and their parent/carers) will be recruited from at least 6 sites in England. The primary outcome is a clinician-made diagnosis about the presence of an emotional disorder within 12 months of randomisation. Secondary outcomes include referral acceptance, diagnosis and treatment of emotional disorders, symptoms of emotional difficulties and comorbid disorders and associated functional impairment. ETHICS AND DISSEMINATION The study received favourable opinion from the South Birmingham Research Ethics Committee (Ref. 19/WM/0133). Results of this trial will be reported to the funder and published in full in the Health Technology Assessment (HTA) Journal series and also submitted for publication in a peer reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN15748675; Pre-results.
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Affiliation(s)
- Florence Day
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Laura Wyatt
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anupam Bhardwaj
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Bernadka Dubicka
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Colleen Ewart
- STADIA Patient and Public Involvement co-lead, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Julia Gledhill
- Central and North West London NHS Foundation Trust, London, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alexandra Lang
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | | | - Alan Montgomery
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise Thomson
- Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ellen Bradley
- Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - James Lathe
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kristina Newman
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Chris Partlett
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kath Starr
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Unit of Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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Herring GT, Loades ME, Higson‐Sweeney N, Hards E, Reynolds S, Midgley N. The experience of cognitive behavioural therapy in depressed adolescents who are fatigued. Psychol Psychother 2022; 95:234-255. [PMID: 34545986 PMCID: PMC9292929 DOI: 10.1111/papt.12365] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 09/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD. DESIGN A qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study. METHODS Data were obtained from semi-structured interviews conducted after therapy. Participants were 18 adolescents (aged 13-18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis. RESULTS Three themes and seven sub-themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled adolescents to open up in sessions. When the therapist was not perceived as genuine, adolescents appeared to find CBT less helpful. The structure of CBT appeared to enable treatment goals to be set, and facilitated an increase in meaningful activity. Ensuring that tasks were perceived as manageable and goals as achievable seemed important for participation. Cognitive restructuring appeared useful, although some adolescents tended to engage in distraction from thoughts as an alternative strategy. CONCLUSIONS This study provides an initial insight into how fatigued adolescents with MDD experience CBT. Further research is required to establish whether the themes are pervasive and relatedly, how best to treat depression in fatigued adolescents receiving CBT. PRACTITIONER POINTS Fatigued adolescents with depression found engaging in CBT sessions and therapeutic homework demanding. Establishing a collaborative therapeutic relationship, where the therapist was perceived as genuine, appeared helpful for participation. The structured approach to therapy, combined with flexibility, was experienced as helpful. Adolescents who perceived the pace of sessions to be manageable and therapeutic goals as achievable seemed to find CBT helpful overall. These findings provide insight into how fatigued adolescents with depression experience CBT and highlight the importance of being aware of fatigue and adapting therapy accordingly.
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Affiliation(s)
| | - Maria Elizabeth Loades
- Department of PsychologyUniversity of BathUK,Bristol Medical SchoolUniversity of BristolUK
| | | | - Emily Hards
- Department of PsychologyUniversity of BathUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language StudiesUniversity of ReadingUK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health PsychologyUniversity College LondonUK,Child Attachment and Psychological Therapies Research Unit (ChAPTRe)Anna Freud National Centre for Children and FamiliesLondonUK
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Loades ME, St Clair MC, Orchard F, Goodyer I, Reynolds S. Depression symptom clusters in adolescents: A latent class analysis in a clinical sample. Psychother Res 2022; 32:860-873. [PMID: 35109777 DOI: 10.1080/10503307.2022.2030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Major depression is clinically heterogeneous. We aimed to identify classes of depressed adolescents with different symptom presentations and examine if these were differentially associated with illness severity, functioning, engagement with treatment, and clinical outcomes. METHOD Baseline depression symptoms of 454 depressed adolescents (age 11-17) from the IMPACT trial were subjected to latent class analysis. We compared classes on self-reported symptoms and social impairment at baseline and follow-up and their engagement in treatment. RESULTS We identified three classes of participants which differed in the number and pattern of depression symptoms; Class 1-Severe- (37.2%)-endorsed almost all symptoms and were most functionally impaired; Class 2-Moderate- (41.9%)-endorsed fewer symptoms with high suicidal ideation, self-harm, and worthlessness; Class 3-Somatic (20.9%)-endorsed fewest symptoms, with high somatic symptoms. Groups did not differ on engagement, therapeutic alliance, or post-treatment symptom reduction. Adolescents in the severe and moderate subgroups reported symptom reductions after treatment ended, whilst those in the somatic subgroup did not. CONCLUSIONS At presentation, high somatic features in depressed adolescents, rather than severity, or impairment levels, may indicate lower liability for responding to psychological treatment.
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Affiliation(s)
- Maria E Loades
- Department of Psychology, University of Bath, Bath, United Kingdom
| | | | - Faith Orchard
- Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Ian Goodyer
- Department of Psychiatry, Douglas House, University of Cambridge, Cambridge, United Kingdom
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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- Department of Psychiatry, Douglas House, University of Cambridge, Cambridge, United Kingdom
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15
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Sprungl K, Arena H, Reynolds S, Whitaker B. 170 Acetylation patterns of histone H3K27 in aged pig oocytes. Reprod Fertil Dev 2021; 34:323. [PMID: 35231380 DOI: 10.1071/rdv34n2ab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- K Sprungl
- University of Findlay, Findlay, OH, USA
| | - H Arena
- University of Findlay, Findlay, OH, USA
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16
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Reynolds S, Springl K, Arena H, Whitaker B. 149 Effects of quisqualic acid and L-α-amino butyrate supplementation during in vitro oocyte maturation on embryonic development in pigs. Reprod Fertil Dev 2021; 34:312-313. [PMID: 35231356 DOI: 10.1071/rdv34n2ab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S Reynolds
- The University of Findlay, Findlay, OH, USA
| | - K Springl
- The University of Findlay, Findlay, OH, USA
| | - H Arena
- The University of Findlay, Findlay, OH, USA
| | - B Whitaker
- The University of Findlay, Findlay, OH, USA
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17
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List R, Soper M, Bruschwein H, Williamson L, Reynolds S, Kalenga C, Gravley K, Starheim E, Murray R, Compton M, Jennings D, Gettle L, Somerville L, Albon D. 342: From concept to reality—Building conditions to support a patient advisory council. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Schlimm K, Loades M, Hards E, Reynolds S, Parkinson M, Midgley N. 'It's always difficult when it's family. . . whereas when you're talking to a therapist. . .': Parents' views of cognitive-behaviour therapy for depressed adolescents. Clin Child Psychol Psychiatry 2021; 26:1018-1034. [PMID: 34011197 PMCID: PMC8593316 DOI: 10.1177/13591045211013846] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parents are key to helping their adolescent child access psychological therapy for mental health problems such as depression. However, little is known about how parents experience their child's psychological therapy. We aimed to explore parents' experiences of their adolescent child's cognitive behaviour therapy for depression. METHOD We applied Thematic Analysis (TA) to qualitative data from in-depth interviews with parents (N = 16) whose adolescent child was randomly allocated to CBT in a large multisite RCT for adolescent depression (the IMPACT trial). Interviews were conducted at the end of treatment. RESULTS We generated two main themes: parents' perceptions of the adolescent's journey through therapy, and parents' perceptions of the therapeutic setting and process. Each included four sub-themes. Parents talked about key factors that impacted on their child's progress through treatment, including the adolescent's readiness for therapy and the adolescent-therapist relationship. CONCLUSION Parents' insights confirm the foundations of what is considered good clinical practice of CBT for adolescent depression, including tailoring therapy to the adolescent, and establishing a strong adolescent-therapist relationship. Parents recognised that, for CBT to be helpful, their child had to be willing to engage in therapy and able to develop a trusting relationship with their therapist.
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Affiliation(s)
| | - Maria Loades
- Department of Psychology, University of Bath, UK.,Bristol Medical School, University of Bristol, UK
| | - Emily Hards
- Department of Psychology, University of Bath, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Studies, University of Reading, UK
| | - Monika Parkinson
- School of Psychology and Clinical Language Studies, University of Reading, UK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
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19
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Watson R, McCabe C, Harvey K, Reynolds S. Development and validation of a new adolescent self-report scale to measure loss of interest and pleasure: The Anhedonia Scale for Adolescents. Psychol Assess 2021; 33:201-217. [PMID: 33779202 DOI: 10.1037/pas0000977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anhedonia, the loss of interest and pleasure in previously enjoyable experiences, is a core symptom of depression and a characteristic of other mental health and physical health problems. Most self-report measures of anhedonia has been developed for use with adults and their suitability for adolescents is questionable. In this article, we describe the development and psychometric qualities of a new measure, the Anhedonia Scale for Adolescents (ASA), designed specifically for use with adolescents aged 11-18 years. Items were generated from in-depth qualitative interviews with depressed young people, and then reviewed by an independent group of young people and clinically qualified experts in adolescent mental health. After piloting the new scale (n = 66), we established the structural validity of the measure with two groups of young people using exploratory (n = 1057) and confirmatory (n = 1041) factor analysis. The final scale consisted of 14 items, with 1 general factor and 3 specific factors producing the best fit to the data, (1) Enjoyment, Excitement, and Emotional Flattening (negatively framed); (2) Enthusiasm, Connection, and Purpose (positively framed); and (3) Effort, Motivation, and Drive (negatively framed). The ASA had high test-retest reliability and converged with standardized measures of depression, negative symptoms of schizophrenia, pleasure, and positive affect. Findings from these analyses provided evidence of incremental validity, as the ASA was a stronger predictor of clinical group (high vs. low depressive symptoms) than existing measures used to assess anhedonia. The ASA has potential as a new clinical and research tool to assess adolescent anhedonia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Ciara McCabe
- School of Psychology and Clinical Language Sciences
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences
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20
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Cooper K, Hards E, Moltrecht B, Reynolds S, Shum A, McElroy E, Loades M. Loneliness, social relationships, and mental health in adolescents during the COVID-19 pandemic. J Affect Disord 2021; 289:98-104. [PMID: 33962368 PMCID: PMC9310699 DOI: 10.1016/j.jad.2021.04.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 04/17/2021] [Indexed: 12/18/2022]
Abstract
Loneliness is a common experience in adolescence and is related to a range of mental health problems. Such feelings may have been increased by social distancing measures introduced during the COVID-19 pandemic. We aimed to investigate the effect of loneliness, social contact, and parent relationships on adolescent mental health during lockdown in the UK. Young people aged 11-16 years (n = 894) completed measures of loneliness, social contact, parent-adolescent relationships, and mental health difficulties during the first 11 weeks of lockdown and one-month later (n = 443). We examined cross-sectional associations and longitudinal relationships between loneliness, social contact, and parent relationships and subsequent mental health. Adolescents who reported higher loneliness had significantly higher symptoms of mental health difficulties during lockdown. We found that adolescents who had closer relationships with their parents reported significantly less severe symptoms of mental health difficulties and lower levels of loneliness. We also found that adolescents who spent more time texting others reported higher symptoms of mental health difficulties. Our hypothesis that loneliness would predict poorer mental health one month later was not supported. Time spent texting others at baseline was significantly associated with higher hyperactivity at follow-up, and closeness to parents was significantly associated with lower psychological distress at follow-up. We conclude that while loneliness was associated with greater mental health difficulties at baseline, it did not predict increased mental health difficulties one month later. Moreover, existing mental health problems significantly predicted later increase, thereby highlighting the importance of continuing support for vulnerable people.
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Affiliation(s)
- Kate Cooper
- Department of Psychology, University of Bath, UK.
| | - Emily Hards
- Department of Psychology, University of Bath, UK
| | - Bettina Moltrecht
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Adrienne Shum
- Departments of Experimental Psychology and Psychiatry, University of Oxford, UK
| | - Eoin McElroy
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Maria Loades
- Department of Psychology, University of Bath, UK; Bristol Medical School, University of Bristol, UK
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21
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Watson R, Harvey K, Pass L, McCabe C, Reynolds S. A qualitative study exploring adolescents' experience of brief behavioural activation for depression and its impact on the symptom of anhedonia. Psychol Psychother 2021; 94:266-288. [PMID: 32918843 DOI: 10.1111/papt.12307] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Anhedonia, the loss of interest and pleasure, is a core symptom of depression and is associated with deficits in reward processing. Behavioural Activation for depression may address this symptom due to its focus on identifying and increasing intrinsically rewarding activities. DESIGN This was a qualitative study employing reflexive thematic analysis (TA). METHODS Participants were eight treatment-seeking adolescents with a recent primary diagnosis of depression who had received eight sessions of Brief Behavioural Activation. Qualitative semi-structured interviews were conducted after treatment was completed. RESULTS Three main themes emerged: (1) connecting, reviewing, and taking action: 'focus on getting better rather than what you're feeling'; (2) struggles, restrictors, and motivators: 'it seemed really unachievable'; and (3) feeling, acting, or seeing things differently: 'looking forwards in a more healthy way'. CONCLUSIONS Both specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic strategies (e.g., self-monitoring) may be helpful in treating the symptom of anhedonia in adolescent depression. Motivational aspects of anhedonia, as well as anxiety, fatigue, and academic pressures act as potential barriers to recovery. This highlights the need for psychological treatments for adolescent depression to include explicit and targeted strategies to enhance motivation. PRACTITIONER POINTS Young people reported that specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic techniques (e.g., self-monitoring) had a role in treating anhedonia. Barriers to engaging in Brief BA included: motivational anhedonia, fatigue, and academic demands.
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Affiliation(s)
| | | | - Laura Pass
- University of Reading, UK.,University of East Anglia, Norwich, UK
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22
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Fuseekul N, Orchard F, Reynolds S. Psychometric properties of the Thai Mood and Feelings Questionnaire (MFQ) for adolescent depression. Child Adolesc Psychiatry Ment Health 2021; 15:17. [PMID: 33836780 PMCID: PMC8035723 DOI: 10.1186/s13034-021-00372-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity and to determine the optimal clinical cut-off of the Thai MFQ. METHODS The Thai MFQ was evaluated in two parts. In part 1, The MFQ was translated and back translated into the Thai language and piloted on a small number of Thai adolescents. Then 1275 young people aged 12-18 years from three secondary schools in Thailand completed the MFQ and related measures of depression. In part 2, 138 students were invited to take part in a structured diagnostic interview (the Thai translation of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (the K-SADS-PL). Of those, 103 students were interviewed and completed the Thai MFQ a second time to assess test-retest reliability. Receiver Operating Characteristics (ROC) analyses were conducted to evaluate diagnosis accuracy and examine the optimal cut-off score of the Thai MFQ. RESULTS The Thai MFQ had excellent internal consistency (α = 0.92) and good to moderate test-retest reliability in 2-week and 4-week intervals. The Thai MFQ also had good convergent validity with related measures of depression. The ROC analyses demonstrated that the Thai MFQ also had excellent accuracy distinguishing between depressed and non-depressed adolescents [AUC = 0.95, 95% CI [0.92, 0.99]. A total score of 28 on the Thai MFQ was the optimal cut-off score (sensitivity was 0.97 and specificity was 0.83). DISCUSSION The Thai MFQ demonstrated excellent psychometric properties and accurately distinguished between depressed and non-depressed adolescents. It is appropriate to use as a screening measure to identify adolescents with depression in community settings in Thailand.
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Affiliation(s)
- Nanthaka Fuseekul
- School of Psychology and Clinical Language School Sciences, University of Reading, Reading, RG6 6AL, UK.
| | - Faith Orchard
- grid.12082.390000 0004 1936 7590School of Psychology, University of Sussex, Sussex, UK
| | - Shirley Reynolds
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language School Sciences, University of Reading, Reading, RG6 6AL UK
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23
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Lewis-Smith I, Pass L, Jones DJW, Reynolds S. “… if I care about stuff, then other people care about me”. Adolescents’ experiences of helpful and unhelpful aspects of brief behavioural activation therapy for depression. Psychother Res 2021; 31:1067-1078. [DOI: 10.1080/10503307.2021.1898692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Iona Lewis-Smith
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laura Pass
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Dan J W Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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24
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Creswell C, Leigh E, Larkin M, Stephens G, Violato M, Brooks E, Pearcey S, Taylor L, Stallard P, Waite P, Reynolds S, Taylor G, Warnock-Parkes E, Clark DM. Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study. Health Technol Assess 2021; 25:1-94. [PMID: 33759742 PMCID: PMC8020199 DOI: 10.3310/hta25200] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD. OBJECTIVES To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used. DESIGN During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads. SETTING Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts. PARTICIPANTS Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews. INTERVENTIONS Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A). MAIN OUTCOME MEASURES Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians' logs. RESULTS Nine out of 12 participants achieved good outcomes across measures (r ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context. LIMITATIONS Findings were based on a small, homogeneous sample and there was no comparison arm. CONCLUSIONS CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation. FUTURE WORK Further work is needed to ensure that CAMHS can incorporate and test CT-SAD-A. Alternatively, CT-SAD-A should be delivered and tested in other settings that are better configured to treat young people whose lives are held back by SAD. The new schools Mental Health Support Teams envisaged in the 2017 Children's Mental Health Green Paper may provide such an opportunity. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme. Individual funding was also provided for Cathy Creswell, David M Clark and Eleanor Leigh as follows: NIHR Research Professorship (Cathy Creswell); Wellcome Senior Investigator Award (Anke Ehlers and David M Clark); and the Wellcome Clinical Research Training Fellowship (Eleanor Leigh).
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Affiliation(s)
- Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | | | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Emma Brooks
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Samantha Pearcey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lucy Taylor
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Paul Stallard
- Child and Adolescent Mental Health Service, Oxford Health NHS Trust, Bristol, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Abstract
An important component of some psychological therapies is the use of clients' values to motivate behaviour change. Values are understood to be developed during childhood and adolescence but there has been limited exploration of how young people experience values and their function across contexts. This study aimed to explore adolescents' understanding of the concept of 'values' and to elicit their experiences of values. Semi-structured, individual interviews were conducted with 11 adolescents aged 12-17 years. Thematic analysis was used to identify themes. Young people were readily able to discuss the meaning of 'values' and their own personal values. Three main themes were identified: (1) what values are (in general, and specific to themselves), (2) where values come from (relationships, education, growing up), and (3) why values are important (prioritising/decision making, reflecting on values is helpful). The adolescents in this study demonstrated an in-depth understanding of the meaning, origins and functions of values. The results suggest young people may welcome and benefit from opportunities to discuss their values, including in therapy.
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Affiliation(s)
- Iona Lewis-Smith
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laura Pass
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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26
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Abstract
It is heartening to see that our rapid systematic review1 is stimulating others to highlight the needs of particular subsets of vulnerable children and adolescents. We found evidence that loneliness in children and adolescents is associated with increased depression and anxiety symptoms both cross-sectionally and longitudinally. We agree with Dr. Morrissette2 that children and adolescents with social phobia merit additional consideration in the 2019 novel coronavirus disease (COVID-19) pandemic. Speculatively, we suggest that many children and adolescents who did not have social phobia before the pandemic may begin to experience worries about social situations as schools reopen. Furthermore, we hypothesize that a range of mental health symptoms including social phobia are likely to become more obvious as many pupils return to school.
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Affiliation(s)
- Maria Elizabeth Loades
- University of Bath, Claverton Down, Bath, and the University of Bristol, United Kingdom.
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
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Brett S, Reynolds S, Totman J, Pass L. Brief behavioural activation therapy for adolescent depression in schools: two case examples. Emotional and Behavioural Difficulties 2020. [DOI: 10.1080/13632752.2020.1861853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Simon Brett
- Charlie Waller Institute & AnDY Research Unit, School of Psychology and Clinical Language Sciences, University of Reading , Reading, UK
- Department of Education, Macquarie University , Sydney, Australia
| | - Shirley Reynolds
- Charlie Waller Institute & AnDY Research Unit, School of Psychology and Clinical Language Sciences, University of Reading , Reading, UK
| | - Jonathan Totman
- Charlie Waller Institute & AnDY Research Unit, School of Psychology and Clinical Language Sciences, University of Reading , Reading, UK
| | - Laura Pass
- Charlie Waller Institute & AnDY Research Unit, School of Psychology and Clinical Language Sciences, University of Reading , Reading, UK
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia , Norwich, UK
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28
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Stuijfzand S, Stuijfzand B, Reynolds S, Dodd H. Anxiety-Related Attention Bias in Four- to Eight-Year-Olds: An Eye-Tracking Study. Behav Sci (Basel) 2020; 10:bs10120194. [PMID: 33348888 PMCID: PMC7766356 DOI: 10.3390/bs10120194] [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: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Background: There is evidence of an attention bias–anxiety relationship in children, but lack of appropriate methods has limited the number of studies with children younger than eight years old. This study used eye tracking as a measure of overt attention in young children. The aim of this study was to assess anxiety-related attention bias in children aged four to eight years. Age was considered a moderator, and the influence of effortful control was investigated. (2) Method: A community sample of 104 children was shown pairs of happy–neutral and angry–neutral faces. Growth curve analyses were used to examine patterns of gaze over time. (3) Results: Analyses revealed moderation by age and anxiety, with distinct patterns of anxiety-related biases seen in different age groups in the angry–neutral face trials. Effortful control did not account for age-related effects. (4) Conclusions: The results support a moderation model of the development of anxiety in children.
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Affiliation(s)
- Suzannah Stuijfzand
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
| | | | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
- Correspondence:
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29
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Sheill G, Reynolds S, O'Neill L, Mockler D, Reynolds JV, Hussey J, Guinan E. Cardiopulmonary Exercise Testing in Oesophagogastric Surgery: a Systematic Review. J Gastrointest Surg 2020; 24:2667-2678. [PMID: 32632727 DOI: 10.1007/s11605-020-04696-2] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPX) can objectively measure fitness and oxygen uptake at anaerobic threshold. The relationship between fitness and postoperative outcomes after upper gastro-intestinal surgery is unclear. The aim of the present review is to assess the prognostic ability of CPX in predicting postoperative outcome associated with oesophagogastric surgery. METHODS Relevant studies were identified through a systematic search of EMBASE, Medline, CINAHL, Cochrane Library, and Web of Science to July 2019. The eligibility criteria for studies included prognostic studies of upper gastro-intestinal surgery among adult populations using a preoperative CPX and measurement of postoperative outcome (mortality or morbidity or length of stay). Risk of bias was assessed using the QUIPS Quality in Prognostic Studies validated tool. RESULTS Thirteen papers with a total of 1735 participants were included in data extraction. A total of 7 studies examined the association between CPX variables and postoperative mortality. Patients undergoing gastro-intestinal surgery with lower anaerobic threshold values were found to have an increased risk of postoperative mortality. Similarly, a lower rate of oxygen consumption was found to be associated with higher mortality. There was conflicting evidence regarding the association between CPX variables and postoperative morbidity. The evidence did not demonstrate any association between preoperative CPX variables and hospital length of stay. CONCLUSION Studies report an association between CPX variables and postoperative mortality; however, there is conflicting evidence regarding the association between CPX variables and postoperative morbidity.
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Affiliation(s)
- G Sheill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - S Reynolds
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - L O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - D Mockler
- Medical Library, Trinity College Dublin, Dublin, Ireland
| | - J V Reynolds
- Department of Surgery, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - J Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - E Guinan
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
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Orchard F, Gregory AM, Gradisar M, Reynolds S. Self-reported sleep patterns and quality amongst adolescents: cross-sectional and prospective associations with anxiety and depression. J Child Psychol Psychiatry 2020; 61:1126-1137. [PMID: 32557672 DOI: 10.1111/jcpp.13288] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 12/16/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sleep problems are common in adolescence, and frequently comorbid with both anxiety and depression. Research studies have suggested a bidirectional relationship between sleep and psychopathology, which includes evidence that sleep interventions can alleviate symptoms of anxiety and depression. However, little is known about the nature of sleep problems amongst adolescents with anxiety and depression, and whether specific sleeping difficulties are involved in the longitudinal relationship between sleep, anxiety and depression. METHOD The sample was derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective, birth cohort study of children born in 1991-1992. Data were explored from a subset of participants who took part in a clinical assessment at age 15, on self-report sleep patterns and quality, and diagnostic outcomes of anxiety and depression (N = 5,033). Subsequent diagnostic and symptom severity data on anxiety and depression at ages 17, 21 and 24 were also examined. RESULTS Cross-sectional and longitudinal analyses were conducted to explore the relationship between sleep problems, anxiety and depression. Results revealed that adolescents aged 15 with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only reported problems with sleep quality. A range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and the diagnoses of anxiety and depressive disorders at age 17, 21 and 24 years. CONCLUSIONS The results provide further insight into the nature of sleep problems amongst adolescents with anxiety and depression, and the prospective relationship between sleep disturbance and future psychopathology. These data suggest that targeting sleep difficulties during adolescence may have long-term mental health benefits.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Aitken M, Haltigan JD, Szatmari P, Dubicka B, Fonagy P, Kelvin R, Midgley N, Reynolds S, Wilkinson PO, Goodyer IM. Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents. J Child Psychol Psychiatry 2020; 61:998-1008. [PMID: 31930507 PMCID: PMC7496892 DOI: 10.1111/jcpp.13194] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision-making. METHODS Participants were adolescents with major depressive disorder (aged 11-17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytic psychotherapy, and brief psychosocial intervention. Self-reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling. RESULTS General psychopathology factor scores decreased across treatment and one-year follow-up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow-up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions-compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow-up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short-term psychoanalytic psychotherapy. CONCLUSIONS The clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal-focused approach may be indicated for youth with comorbid conduct problems.
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Affiliation(s)
- Madison Aitken
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - John D. Haltigan
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Hospital for Sick ChildrenTorontoONCanada
| | - Peter Szatmari
- Cundill Centre for Child and Youth DepressionCentre for Addiction and Mental HealthTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada,Hospital for Sick ChildrenTorontoONCanada
| | - Bernadka Dubicka
- Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Peter Fonagy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Raphael Kelvin
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | | | - Ian M. Goodyer
- Department of PsychiatryUniversity of CambridgeCambridgeUK
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Orchard F, Pass L, Chessell C, Moody A, Ellis J, Reynolds S. Adapting Brief CBT-I for Depressed Adolescents: A Case Illustration of the Sleeping Better Program. Cognitive and Behavioral Practice 2020. [DOI: 10.1016/j.cbpra.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gee B, Reynolds S, Carroll B, Orchard F, Clarke T, Martin D, Wilson J, Pass L. Practitioner Review: Effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review. J Child Psychol Psychiatry 2020; 61:739-756. [PMID: 32250447 DOI: 10.1111/jcpp.13209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. METHODS Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. RESULTS Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = .34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD = -.49, 95% CI -0.79, -0.19) immediately postintervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤ 12) or long-term (>12-month) follow-up. Reductions in anxiety symptoms were not maintained at any follow-up. CONCLUSIONS Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately postintervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence base. Further high-quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety.
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Affiliation(s)
- Brioney Gee
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Ben Carroll
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Clarke
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Martin
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jon Wilson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Norwich Medical School, University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Wilmots E, Midgley N, Thackeray L, Reynolds S, Loades M. The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychol Psychother 2020; 93:276-291. [PMID: 31119849 PMCID: PMC7216827 DOI: 10.1111/papt.12232] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 01/05/2019] [Revised: 03/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This paper aimed to explore client experiences of the therapeutic relationship among adolescents with good outcomes after receiving Cognitive Behaviour Therapy (CBT) for moderate to severe depression. DESIGN This was a qualitative study employing Interpretative Phenomenological Analysis (IPA). METHODS As part of a randomized clinical trial, 77 adolescents with moderate to severe depression were interviewed using a semi-structured interview, which was audio-recorded. Five of these interviews, with adolescents aged 14-18 years who completed CBT and had good outcomes, were purposively sampled and analysed using IPA. RESULTS The findings indicated that a positive therapeutic relationship was fostered with therapists who respected the adolescents' autonomy and sense of individuality, while offering experiences of emotional closeness and connection. This was achieved by balancing the dual roles of being 'friendly' and affable, with being a 'professional expert' thereby embodying a collaborative and egalitarian approach. CONCLUSIONS The therapeutic relationship in CBT can help to motivate adolescents to engage with cognitively and emotionally challenging tasks. By providing an understanding of what helps and hinders the development of a positive therapeutic relationship, the current findings offer important insight into how therapists can foster positive relationships with depressed adolescents. This knowledge will make it more likely that adolescents will engage in the treatment process and in turn experience greater therapeutic gains. PRACTITIONER POINTS Offers a detailed phenomenological analysis of what fostered a positive therapeutic relationship in good outcome CBT, and what was experienced as harmful from the adolescents' perspective. Provides support that the therapeutic relationship is crucial in CBT; a respectful and understanding relationship provides a platform for the adolescent to carry out CBT activities and tasks.
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Affiliation(s)
- Eva Wilmots
- UCL and the Anna Freud National Centre for Children and FamiliesLondonUK
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe)UCL and the Anna Freud National Centre for Children and FamiliesLondonUK
| | - Lisa Thackeray
- UCL and the Anna Freud National Centre for Children and FamiliesLondonUK
| | - Shirley Reynolds
- Charlie Waller InstituteSchool of Psychology and Clinical Language SciencesUniversity of ReadingUK
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Calvert SJ, Reynolds S, Paley MN, Walters SJ, Pacey AA. Probing human sperm metabolism using 13C-magnetic resonance spectroscopy. Mol Hum Reprod 2020; 25:30-41. [PMID: 30395244 PMCID: PMC6314230 DOI: 10.1093/molehr/gay046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/01/2018] [Indexed: 02/04/2023] Open
Abstract
STUDY QUESTION Can 13C-Magnetic Resonance Spectroscopy (MRS) of selected metabolites provide useful information about human sperm metabolism and how glycolysis or oxidative phosphorylation are used by different sperm populations? SUMMARY ANSWER Sperm populations, prepared by density gradient centrifugation (DGC) and incubated with either 13Cu-glucose, 13Cu-fructose or 13C1-pyruvate, showed consistent evidence of metabolism generating principally lactate and more intermittently bicarbonate, and significantly more lactate was produced from 13Cu-glucose by vital or motile sperm recovered from the 40/80% interface compared to those from the pellet, which could not be accounted for by differences in the non-sperm cells present. WHAT IS KNOWN ALREADY Previous studies have focused on CO2 or other specific metabolite production by human sperm and there remains considerable debate about whether glycolysis and/or oxidative phosphorylation is the more important pathway for ATP production in sperm. STUDY DESIGN, SIZE, DURATION Sperm populations were prepared by DGC and subjected to 13C-MRS to answer the following questions. (i) Is it possible to detect human sperm metabolism of 13C substrates implicated in energy generation? (ii) What are the kinetics of such reactions? (iii) Do different sperm populations (e.g. '80%' pellet sperm and '40%' interface sperm) utilise substrates in the same way? Semen samples from 97 men were used in these experiments; 52 were used in parallel for aims (i) and (ii) and 45 were used for aim (iii). PARTICIPANTS/MATERIALS, SETTING, METHODS Sperm populations were prepared from ejaculates of healthy men using a Percoll/Phosphate Buffered Saline (PBS) DGC and then incubated with a range of 13C-labelled substrates (13Cu-glucose, 13Cu-fructose, 13C1-pyruvate, 13C1-butyrate, 13C3-lactate, 13C2,4-D-3-hydroxybutyrate, 13C5-l-glutamate, 13C1,2-glycine or 13Cu-galactose) along with penicillin/streptomycin antibiotic at 37°C for 4 h, 24 h or over 48 h for an estimated rate constant. Sperm concentration, vitality and motility were measured and, for a subset of experiments, non-sperm cell concentration was determined. A 9.4 T magnetic resonance spectrometer was used to acquire 1D 13C, inverse gated 1H decoupled, MRS spectra. Spectrum processing was carried out using spectrometer software and Matlab scripts to determine peak integrals for each spectrum. MAIN RESULTS AND THE ROLE OF CHANCE 13Cu-glucose, 13Cu-fructose and 13C1-pyruvate were consistently converted into lactate and, to a lesser extent, bicarbonate. There was a significant correlation between sperm concentration and lactate peak size for 13Cu-glucose and 13Cu-fructose, which was not observed for 13C1-pyruvate. The lactate peak did not correlate with the non-sperm cell concentration up to 6.9 × 106/ml. The concentration of 13Cu-glucose, 13Cu-fructose or 13C1-pyruvate (1.8, 3.6, 7.2 or 14.4 mM) had no influence on the size of the observed lactate peak over a 4 h incubation. The rate of conversion of 13C1-pyruvate to lactate was approximately three times faster than for 13Cu-glucose or 13Cu-fructose which were not significantly different from each other. After incubating for 4 h, the utilisation of 13Cu-glucose, 13Cu-fructose or 13C1-pyruvate by sperm from the '40%' interface of the DGC was no different from those from the pellet when normalised to total sperm concentration. However, after normalising by either the vital or motile sperm concentration, there was a significant increase in conversion of 13Cu-glucose to lactate by '40%' interface sperm compared to pellet sperm (Vital = 3.3 ± 0.30 × 106 vs 2.0 ± 0.21 × 106; P = 0.0049; Motile = 7.0 ± 0.75 × 106 vs 4.8 ± 0.13 × 106; P = 0.0032. Mann-Whitney test P < 0.0055 taken as statistically significant). No significant differences were observed for 13Cu-fructose or 13C1-pyruvate. LARGE SCALE DATA Not applicable. LIMITATIONS, REASONS FOR CAUTION Only 13C labelled metabolites that accumulate to a sufficiently high concentration can be observed by 13C MRS. For this reason, intermediary molecules in the metabolic chain are difficult to observe without trapping the molecule at a particular step using inhibitors. Non-sperm cell concentration was typical of the general population and no link was found between these cells and the magnitude of the 13C-lactate peak. However, it is possible that higher concentrations than the maximum observed (6.9 × 106/ml) may contribute to exogenous substrate metabolism in other experiments. WIDER IMPLICATIONS OF THE FINDINGS 13C-MRS can provide information on the underlying metabolism of multiple pathways in live sperm. Dysfunction in sperm metabolism, as a result of either impaired enzymes of lack of metabolisable substrate, could be detected in sperm by a non-destructive assay, potentially offering new treatment options to improve overall sperm quality and outcomes for reproduction. STUDY FUNDING AND COMPETING INTERESTS This work was supported by the Medical Research Council Grant MR/M010473/1. The authors declare no conflicts of interest.
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Affiliation(s)
- S J Calvert
- Academic Unit of Reproductive & Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, UK
| | - S Reynolds
- Academic Unit of Radiology, Department of Immunity, Infection and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - M N Paley
- Academic Unit of Radiology, Department of Immunity, Infection and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - S J Walters
- School of Health Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
| | - A A Pacey
- Academic Unit of Reproductive & Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, UK
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Davies SE, Neufeld SA, van Sprang E, Schweren L, Keivit R, Fonagy P, Dubicka B, Kelvin R, Midgley N, Reynolds S, Target M, Wilkinson P, van Harmelen AL, Goodyer IM. Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression. J Child Psychol Psychiatry 2020; 61:565-574. [PMID: 31647124 PMCID: PMC7216986 DOI: 10.1111/jcpp.13145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/10/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (≤27) and a symptom reduction score (≥50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered.
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Affiliation(s)
| | | | | | - Lizanne Schweren
- Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rogier Keivit
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | | | - Raphael Kelvin
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Mary Target
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Paul Wilkinson
- Department of PsychiatryUniversity of CambridgeCambridgeUK
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Watson R, Harvey K, McCabe C, Reynolds S. Understanding anhedonia: a qualitative study exploring loss of interest and pleasure in adolescent depression. Eur Child Adolesc Psychiatry 2020; 29:489-499. [PMID: 31270605 PMCID: PMC7103575 DOI: 10.1007/s00787-019-01364-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022]
Abstract
Anhedonia (or loss of interest and pleasure) is a core symptom of depression and may predict poor treatment outcome. However, little is known about the subjective experience of anhedonia, and it is rarely targeted in psychological treatment for depression. The aim of this study is to examine how young people experience anhedonia in the context of depression. Semi-structured interviews were conducted with 34 adolescents with a primary diagnosis of depression (N = 12) or elevated depressive symptoms (N = 22). Thematic analysis was used to identify important aspects of adolescents' experiences. Four main themes were identified: (1) experiencing a loss of joy and a flattening of emotion; (2) struggling with motivation and active engagement; (3) losing a sense of connection and belonging; and (4) questioning sense of self, purpose, and the bigger picture. The results challenge the framing of anhedonia as simply the loss of interest and pleasure. Adolescents reported a range of experiences that mapped closely onto the cluster of negative symptoms associated with schizophrenia and were similar to the sense of 'apathy' characteristic in Parkinson's disease. This highlights the potential benefit of taking a trans-diagnostic approach to understanding and treating reward deficits associated with mental health problems.
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Affiliation(s)
- Rebecca Watson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Ciara McCabe
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Biltcliffe DO, Judd HJ, Wood R, Bushnell AC, Crudington R, Evans RA, Fawcett R, Grange CN, Griffiths W, Hall PS, Harrison AJ, Kidman SL, Meadows G, Reynolds S, Rymer TE, Shelton JH. Convection Oven Determination of Loss of Mass on Drying of Quick Frozen French Fried Potatoes: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/67.3.635] [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: 11/12/2022]
Abstract
Abstract
A collaborative study was carried out on one of the methods submitted to the Joint Economic Commission for Europe (ECE)/Codex Alimentarius Commission Group of Experts on the Standardization of Quick Frozen Foods for the determination of moisture in quick frozen french (fried potatoes. The method was based on the determination of loss of mass of the sample on drying in a convection oven 16 h at 103±2°C. Two samples of uncooked quick frozen french fried potatoes and 2 samples of oven quick frozen french fried potatoes were analyzed by 14 and 13 laboratories, respectively. The method is simple and was found to be analytically satisfactory with repeatability and reproducibility values of 0.21 and 2.00 g/100 g french fried potatoes, and 0.29 and 3.00 g/100 g oven french fried potatoes, respectively. The method was adopted by the Group of Experts in preference to other proposed procedures for this determination. The method has been adopted official first action by AOAC.
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Affiliation(s)
- David O Biltcliffe
- Ministry of Agriculture, Fisheries and Food, Haldin House, Old Bank of England Court, Queen St, Norwich, UK NR2 4SX
| | - Hillary J Judd
- Ministry of Agriculture, Fisheries and Food, Haldin House, Old Bank of England Court, Queen St, Norwich, UK NR2 4SX
| | - Roger Wood
- Ministry of Agriculture, Fisheries and Food, Haldin House, Old Bank of England Court, Queen St, Norwich, UK NR2 4SX
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Hards E, Ellis J, Fisk J, Reynolds S. Negative view of the self and symptoms of depression in adolescents. J Affect Disord 2020; 262:143-148. [PMID: 31733458 DOI: 10.1016/j.jad.2019.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/05/2019] [Revised: 10/11/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although negative self-evaluation is a common symptom of depression in adolescents, there is little understanding of how the self is associated with depression. Beck (1967) proposed that a negative view of the self was a 'hallmark' of depression. In contrast Linville (1985; 1987) proposed that holding multiple aspects of the self was associated with lower levels of depression. The aim of this paper is to evaluate these two models of self and depression in adolescents. METHODS Young people aged 13-18 years (n = 822) reported symptoms of depression (the Mood and Feelings Questionnaire) and completed a measure of self-concept, the Twenty Statements Test (TST). We coded responses to the TST to reflect the valance (positive to negative) and the complexity of their self-concept (number of self-aspects). RESULTS Valence, but not complexity, of self-concept was significantly associated with severity of depression symptoms. The valance of young people's self-concept accounted for 25% of the variance in depression symptoms. Adolescent's with more positive self-concept tended to have fewer symptoms of depression. LIMITATIONS The cross-sectional design of this study precludes any conclusions about the causal relationship between depression and negative self-evaluation; experimental and longitudinal research is needed to assess the causal direction of the relationship. CONCLUSIONS The results of this study supported the cognitive model of depression. Negative self-evaluation may constitute a risk factor for depression in adolescents and could offer a potential target for prevention and early intervention in adolescents.
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Affiliation(s)
- Emily Hards
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Road, Reading RG6 6AL, United Kingdom.
| | - Judi Ellis
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Road, Reading RG6 6AL, United Kingdom
| | - Jennifer Fisk
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Road, Reading RG6 6AL, United Kingdom
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights Road, Reading RG6 6AL, United Kingdom
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Geros H, Sizer H, Mifsud N, Reynolds S, Kim DJ, Eaton S, McGorry P, Nelson B, O'Donoghue B. Migrant status and identification as ultra-high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 2020; 141:52-59. [PMID: 31520527 DOI: 10.1111/acps.13099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain migrant groups are more likely to develop a psychotic disorder compared to the native-born populations, and a younger age at migration is associated with greater risk. However, it is not known at which stage migration has an effect on the development of psychotic disorders. We examined whether migrants were more likely to be identified as ultra-high risk for psychosis (UHR) compared to native-born young people and whether migrant status was associated with the risk of transition to a full-threshold psychotic disorder. METHODS The cohort included all young people aged 15-24 who were identified as UHR at a specialist clinic over a five-year period (2012-16). Australian census data were used to obtain the at-risk population. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS 467 young people were identified as UHR, of which 13.5% (n = 63) were born overseas. First-generation migrants were 2.6-fold less likely to be identified as UHR compared to Australian-born young people (IRR = 0.39, 95% CI [0.30, 0.51], P < 0.001). There was no difference between migrant and native-born young people in their risk of transitioning to a psychotic disorder (HR = 0.90, 95% CI [0.39, 2.08], P = 0.81). CONCLUSIONS UHR first-generation migrants may be under-accessing mental health services.
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Affiliation(s)
- H Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - H Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - N Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - D J Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - S Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - P McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - B O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic., Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia.,Orygen Youth Health, Parkville, Vic., Australia
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Orchard F, Pass L, Cocks L, Chessell C, Reynolds S. Examining parent and child agreement in the diagnosis of adolescent depression. Child Adolesc Ment Health 2019; 24:338-344. [PMID: 32677348 DOI: 10.1111/camh.12348] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of depression in adolescents relies on identifying the presence of specific core and additional symptoms. Symptoms can be identified using structured or unstructured interviews and a range of questionnaire measures, which are completed by the young person and by a parent or carer. The aim of this research was to examine the inter- and intra-rater reliability of parent report and adolescent self-report of depression symptoms. METHOD In a sample of parent-child dyads, where young people aged 13-17 were referred to a mental health service for depression, we examined adolescents' (n = 46) and parents' (n = 46) independent responses to the Schedule for Affective Disorders and Schizophrenia in School-Age Children (Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1997, 980) and the Mood and Feelings Questionnaire (Journal of the American Academy of Child and Adolescent Psychiatry, 27, 1988, 726). RESULTS In the clinical interview, diagnostic criteria were more often met based on the adolescent's report, and adolescents endorsed more symptoms of depression than their parents. Tentative results also suggest that parent-child agreement about specific symptoms was low. Comparing different measures of depression revealed that adolescent report on the questionnaire and interview was significantly correlated. However, there was no significant correlation between parent questionnaire and interview report. CONCLUSION These results suggest that relying solely on parents to identify depression in their children may result in young people with depression being missed and therefore untreated. Young people themselves should be encouraged and enabled to recognise the symptoms of depression and have an established pathway to services that offer assessment and treatment. Key Practitioner Message Diagnosis of depression in adolescents requires the identification of specific symptoms and can be identified using interviews or questionnaires. Previous research has suggested that parents and young people provide differing reports regarding symptoms of adolescent depression. Results indicated that diagnostic criteria were more often met based on young person report and that parents reported significantly less symptoms. Parent-child agreement about specific symptoms was found to be low. Assessment of adolescent depression should not rely solely on parental report. Young people should be encouraged and enabled to recognise symptoms of depression and be able to access mental health services.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laura Pass
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Laura Cocks
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Chloe Chessell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Orchard F, Pass L, Reynolds S. 'I Am Worthless and Kind'; the specificity of positive and negative self-evaluation in adolescent depression. Br J Clin Psychol 2019; 58:260-273. [PMID: 30556150 PMCID: PMC6767166 DOI: 10.1111/bjc.12215] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/30/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Adolescence represents a critical phase when the concept of self is developed and consolidated. Depressed adolescents globally endorse more negative and fewer positive self-descriptive words compared with non-depressed adolescents. Yet, the methods used have not allowed for more detailed exploration of the specific content of these self-endorsements. METHODS Adolescents, aged 12-18 years, were recruited from the community (n = 204) and from a child and adolescent mental health service in the UK (n = 87). Participants completed measures of depression and a self-description questionnaire which included 12 positive and 12 negative self-descriptive adjectives. RESULTS As expected, we replicated previous findings that depressive symptoms are associated with global positive and negative self-endorsements. The difference between mean scores was examined for each adjective. Depressed adolescents endorsed all negative adjectives more highly relative to community adolescents; ratings of 'worthless' and 'useless' had the biggest difference between community and depressed adolescents. Surprisingly, a group of positive prosocial self-descriptors were endorsed equally by depressed and community adolescents and were not associated with severity of depressive symptoms. CONCLUSIONS Although depressed adolescents endorsed more negative descriptions of themselves than community adolescents, positive self-endorsements related to their relationships with other people were not impaired. PRACTITIONER POINTS Most highly endorsed self-descriptive negative words by depressed adolescents were 'worthless' and 'useless' Positive prosocial self-descriptive adjectives (i.e., trustworthy, friendly, and kind) were highly endorsed by all young people and were not associated with depression Assessment and treatment should consider the content of adolescent self-evaluation The present study is unable to identify whether young people would produce the same themes of positive and negative words in a free response measure Diagnostic information was only available on the clinical group.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language SciencesUniversity of ReadingUK
| | - Laura Pass
- School of Psychology and Clinical Language SciencesUniversity of ReadingUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language SciencesUniversity of ReadingUK
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Hards E, Ellis J, Fisk J, Reynolds S. Memories of the self in adolescence: examining 6558 self-image norms. Memory 2019; 27:1011-1017. [DOI: 10.1080/09658211.2019.1608256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Emily Hards
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Judi Ellis
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jennifer Fisk
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Smith EM, Reynolds S, Orchard F, Whalley HC, Chan SW. Cognitive biases predict symptoms of depression, anxiety and wellbeing above and beyond neuroticism in adolescence. J Affect Disord 2018; 241:446-453. [PMID: 30145516 DOI: 10.1016/j.jad.2018.08.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/05/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Adolescence represents a period of vulnerability to affective disorders. Neuroticism is considered a heritable risk factor for depression, but is not directly amenable to intervention. Therefore, it is important to identify the contributions of modifiable risk factors. Negative cognitive biases are implicated in the onset and maintenance of affective disorders in adults, and may represent modifiable risk factors in adolescence. AIM(S) This study sought to assess to what extent cognitive biases are able to predict depression, anxiety and wellbeing beyond that of neuroticism in adolescents. METHODS Adolescents (N = 99), recruited from Scottish secondary schools (54.5% female; mean age = 14.7), ensured a sample representing the breadth of the mental health spectrum. In line with prevalence estimates, 18% of this sample demonstrated clinical levels of depression symptoms. Cognitive biases of autobiographical memory, self-referential memory, ambiguous scenarios interpretation, facial expression recognition, rumination and dysfunctional attitudes were assessed. Depression, anxiety, and wellbeing were indexed using the Mood and Feelings Questionnaire, Spence Children's Anxiety Scale and the BBC Subjective Wellbeing Scale. RESULTS Regression analyses demonstrated neuroticism to significantly predict depression, anxiety and wellbeing. The addition of cognitive biases resulted in a significant increase of explained variance with final models explaining just over 50% of variances of depression, anxiety and wellbeing. CONCLUSION These findings demonstrate that cognitive biases explain mental health symptoms over and above that of neuroticism. Depressive symptomology was particularly related to self-referential memory bias, while anxiety was predicted by interpretive bias. The key clinical implication is that targeting specific biases based on diagnostic features may be of particular benefit in alleviating distress and promoting wellbeing.
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Affiliation(s)
- Eilidh M Smith
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
| | | | | | - Heather C Whalley
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Stella Wy Chan
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
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Midgley N, Reynolds S, Kelvin R, Loades M, Calderon A, Martin P, O'Keeffe S. Therapists' techniques in the treatment of adolescent depression. J Psychother Integr 2018; 28:413-428. [PMID: 30518990 DOI: 10.1037/int0000119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 12/11/2022]
Abstract
When comparing the relative effectiveness of different psychological treatment approaches using clinical trials, it is essential to establish fidelity to each manualized therapy, and differentiation between the treatment arms. Yet few psychological therapy trials include details about the assessment of treatment integrity and little is known about the specific techniques used by therapists, or to what degree these techniques are shared or distinct across different therapeutic approaches. The aims of this study were: to establish the fidelity of two established psychological therapies - cognitive-behaviour therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) - in the treatment of adolescent depression; and to examine whether they were delivered with adherence to their respective treatment modalities, and if they could be differentiated from each other and from a reference treatment (a brief psychosocial intervention; BPI). The study also aimed to identify shared and distinct techniques used within and across the three treatments. Audio-tapes (N=230) of therapy sessions, collected as part of a trial, were blind double-rated using the Comparative Psychotherapy Process Scale (CPPS), which includes subscales for cognitive-behavioural and psychodynamic-interpersonal techniques. The treatments were delivered with reasonable fidelity and there was clear differentiation in the use of cognitive-behavioural and psychodynamic-interpersonal techniques between CBT and STPP, and between these two established psychological therapies and BPI. An item-level analysis identified techniques used across all three treatments, techniques that were shared between BPI and CBT, and techniques that were unique to CBT and STPP.
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Affiliation(s)
- Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Calderon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Martin
- Department of Applied Health Research, University College London, London, UK
| | - Sally O'Keeffe
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
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Gee B, Orchard F, Clarke E, Joy A, Clarke T, Reynolds S. The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Med Rev 2018; 43:118-128. [PMID: 30579141 DOI: 10.1016/j.smrv.2018.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
Abstract
Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK.
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ansu Joy
- Norfolk and Suffolk NHS Foundation Trust, UK
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Orchard F, Reynolds S. The combined influence of cognitions in adolescent depression: Biases of interpretation, self-evaluation, and memory. Br J Clin Psychol 2018; 57:420-435. [PMID: 29799126 PMCID: PMC6175080 DOI: 10.1111/bjc.12184] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Depression is characterized by a range of systematic negative biases in thinking and information processing. These biases are believed to play a causal role in the aetiology and maintenance of depression, and it has been proposed that the combined effect of cognitive biases may have greater impact on depression than individual biases alone. Yet little is known about how these biases interact during adolescence when onset is most common. METHODS In this study, adolescents were recruited from the community (n = 212) and from a Child And Adolescent Mental Health Service (n = 84). Participants completed measures of depressive symptoms, interpretation bias, self-evaluation, and recall memory. These included the Mood and Feelings Questionnaire, Ambiguous Scenarios Test for Depression in Adolescents, Self-Description Questionnaire, and an immediate recall task. The clinically referred sample also took part in a formal diagnostic interview. RESULTS Individual cognitive biases were significantly intercorrelated and associated with depression severity. The combination of cognitive biases was a stronger predictor of depression severity than individual biases alone, predicting 60% of the variance in depression severity across all participants. There were two significant predictors, interpretation bias and negative self-evaluation; however, almost all of the variance was explained by negative self-evaluation. CONCLUSIONS The findings support the interrelationship and additive effect of biases in explaining depression and suggest that understanding the way in which cognitive biases interact could be important in advancing methods of identification, early intervention, and treatment. PRACTITIONER POINTS A combination of biases was a better predictor of depression symptom severity than individual biases. Interpretation and self-evaluation were better predictors of depression symptom severity than recall. Negative self-evaluation was the strongest individual predictor of depression symptom severity. Negative self-evaluation was able to classify depressed from non-depressed adolescents. The cross-sectional design of the study precludes any conclusions about the potential causal role of these variables. Different tasks were used to assess different types of cognitive bias meaning that the possible linear operation along an information processing 'pathway' could not be examined.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language SciencesUniversity of ReadingUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language SciencesUniversity of ReadingUK
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Chatur S, Reynolds S, Isaac D, Howlett J, Campbell P. COMPARISON OF CLINICAL PRESENTING FEATURES OF PATIENTS ADMITTED WITH RIGHT VERSUS LEFT PREDOMINANT HEART FAILURE. A SINGLE LARGE TERTIARY REFERRAL CENTRE RETROSPECTIVE STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Reynolds S, Calvert SJ, Paley MN, Pacey AA. 1H Magnetic Resonance Spectroscopy of live human sperm. Mol Hum Reprod 2018; 23:441-451. [PMID: 28431025 PMCID: PMC5909857 DOI: 10.1093/molehr/gax025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/13/2017] [Indexed: 12/02/2022] Open
Abstract
STUDY QUESTION Can 1H Magnetic Resonance Spectroscopy (MRS) be used to obtain information about the molecules and metabolites in live human spermatozoa? SUMMARY ANSWER Percoll-based density gradient centrifugation (DGC) followed by a further two washing steps, yielded enough sperm with minimal contamination (<0.01%) from seminal fluid to permit effective MRS which detected significant differences (P < 0.05) in the choline/glycerophosphocholine (GPC), lipid and lactate regions of the 1H MRS spectrum between sperm in the pellet and those from the 40%/80% interface. WHAT IS KNOWN ALREADY Current methods to examine sperm are either limited in their value (e.g. semen analysis) or are destructive (e.g. immunohistochemistry, sperm DNA testing). A few studies have previously used MRS to examine sperm, but these have either looked at seminal plasma from men with different ejaculate qualities or at the molecules present in pooled samples of lyophilized sperm. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Sperm suspended in phosphate buffered saline (PBS) at 37°C were examined by 1H MRS scanning using a 1H excitation-sculpting solvent suppression sequence after recovery from fresh ejaculates by one of three different methods: (i) simple centrifugation; (ii) DGC with one wash; or (iii) DGC with two washes. In the case of DGC, sperm were collected both from the pellet (‘80%’ sperm) and the 40/80 interface (‘40%’ sperm). Spectrum processing was carried out using custom Matlab scripts to determine; the degree of seminal plasma/Percoll contamination, the minimum sperm concentration for 1H MRS detection and differences between the 1H MRS spectra of ‘40%’ and ‘80%’ sperm. MAIN RESULTS AND THE ROLE OF CHANCE DGC with two washes minimized the 1H MRS peak intensity for both seminal plasma and Percoll/PBS solution contamination while retaining sperm specific peaks. For the MRS scanner used in this study, the minimum sperm concentration required to produce a choline/GPC 1H MRS peak greater than 3:1 signal to noise ratio (SNR) was estimated at ~3 × 106/ml. The choline/GPC and lactate/lipid regions of the 1H spectrum were significantly different by two-way ANOVA analysis (P < 0.0001; n = 20). ROC curve analysis of these region showed significant ability to distinguish between the two sperm populations: choline/GPC ROC AUC = 0.65–0.67, lactate/lipid ROC AUC = 0.86–0.87. LIMITATIONS, REASONS FOR CAUTION Only 3–4 semen samples were used to assess the efficacy of each sperm washing protocol that were examined. The estimated minimum sperm concentration required for MRS is specific to the hardware used in our study and may be different in other spectrometers. Spectrum binning is a low resolution analysis method that sums MRS peaks within a chemical shift range. This can obscure the identity of which metabolite(s) are responsible for differences between sperm populations. Further work is required to determine the relative contribution of somatic cells to the MRS spectrum from the ‘40%’ and ‘80%’ sperm. WIDER IMPLICATIONS OF THE FINDINGS 1H MRS can provide information about the molecules present in live human sperm and may therefore permit the study of the underlying functional biology or metabolomics of live sperm. Given the relatively low concentration of sperm required to obtain a suitable MRS signal (~3 × 106/ml), this could be carried out on sperm from men with oligo-, astheno- or teratozoospermia. This may lead to the development of new diagnostic tests or ultimately novel treatments for male factor infertility. STUDY FUNDING AND COMPETING INTEREST(S) This work was supported by the Medical Research Council Grant MR/M010473/1. The authors declare no conflicts of interest.
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Affiliation(s)
- S Reynolds
- Academic Unit of Radiology, Department of Immunity, Infection and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2JF, UK
| | - S J Calvert
- Academic Unit of Reproductive & Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK
| | - M N Paley
- Academic Unit of Radiology, Department of Immunity, Infection and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2JF, UK
| | - A A Pacey
- Academic Unit of Reproductive & Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK
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Lovell K, Bower P, Gellatly J, Byford S, Bee P, McMillan D, Arundel C, Gilbody S, Gega L, Hardy G, Reynolds S, Barkham M, Mottram P, Lidbetter N, Pedley R, Molle J, Peckham E, Knopp-Hoffer J, Price O, Connell J, Heslin M, Foley C, Plummer F, Roberts C. Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET). Health Technol Assess 2018; 21:1-132. [PMID: 28681717 DOI: 10.3310/hta21370] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Obsessive-Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive-compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive-behavioural therapy (CBT) treatment intensity formats. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive-behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. DESIGN A three-arm, multicentre, randomised controlled trial. SETTING Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. PARTICIPANTS Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale-Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. INTERVENTIONS Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. MAIN OUTCOME MEASURES The primary outcome was OCD symptoms using the Yale-Brown Obsessive Compulsive Scale - Observer Rated. RESULTS Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data were analysed for 473 patients. In the short term, prior to accessing high-intensity CBT, guided self-help demonstrated statistically significant benefits over waiting list, but these benefits did not meet the prespecified criterion for clinical significance [adjusted mean difference -1.91, 95% confidence interval (CI) -3.27 to -0.55; p = 0.006]. Supported cCBT did not demonstrate any significant benefit (adjusted mean difference -0.71, 95% CI -2.12 to 0.70). In the longer term, access to guided self-help and supported cCBT, prior to high-intensity CBT, did not lead to differences in outcomes compared with access to high-intensity CBT alone. Access to guided self-help and supported cCBT led to significant reductions in the uptake of high-intensity CBT; this did not seem to compromise patient outcomes at 12 months. Taking a decision-making approach, which focuses on which decision has a higher probability of being cost-effective, rather than the statistical significance of the results, there was little evidence that supported cCBT and guided self-help are cost-effective at the 3-month follow-up compared with a waiting list. However, by the 12-month follow-up, data suggested a greater probability of guided self-help being cost-effective than a waiting list from the health- and social-care perspective (60%) and the societal perspective (80%), and of supported cCBT being cost-effective compared with a waiting list from both perspectives (70%). Qualitative interviews found that guided self-help was more acceptable to patients than supported cCBT. Professionals acknowledged the advantages of low intensity interventions at a population level. No adverse events occurred during the trial that were deemed to be suspected or unexpected serious events. LIMITATIONS A significant issue in the interpretation of the results concerns the high level of access to high-intensity CBT during the waiting list period. CONCLUSIONS Although low-intensity interventions are not associated with clinically significant improvements in OCD symptoms, economic analysis over 12 months suggests that low-intensity interventions are cost-effective and may have an important role in OCD care pathways. Further research to enhance the clinical effectiveness of these interventions may be warranted, alongside research on how best to incorporate them into care pathways. TRIAL REGISTRATION Current Controlled Trials ISRCTN73535163. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Social Work and Communities, Northumbria University, Newcastle, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Patricia Mottram
- Cheshire & Wirral Partnership, NHS Foundation Trust, Wallasey, UK
| | | | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jo Molle
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Owen Price
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Foley
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
| | - Faye Plummer
- Department of Health Sciences, University of York, York, UK
| | - Christopher Roberts
- Centre for Biostatistics in the Institute of Population Health, University of Manchester, Manchester, UK
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