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Walker CR, Gunasinghe C, Harwood H, Ehsan A, Ahmed F, Dorrington S, Onwumere J, Meriez P, Stanley N, Stoll N, Woodhead C, Hatch SL, Rhead RD. Ethnic inequalities during clinical placement: A qualitative study of student nurses' experiences within the London National Health Service. J Adv Nurs 2024; 80:1497-1510. [PMID: 37788114 DOI: 10.1111/jan.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
AIM To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups. DESIGN A qualitative thematic analysis with an inductive approach. METHODS Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement. RESULTS Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS. CONCLUSION These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity. IMPACT Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.
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Affiliation(s)
- Chenel R Walker
- Department of Psychological Medicine, King's College London, London, UK
| | - Cerisse Gunasinghe
- Department of Psychological Medicine, King's College London, London, UK
- Department of Psychology, City University of London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, King's College London, London, UK
| | - Annahita Ehsan
- Department of Psychological Medicine, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Farah Ahmed
- Department of Psychological Medicine, King's College London, London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Juliana Onwumere
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Paula Meriez
- Department of Psychological Medicine, King's College London, London, UK
| | - Nathan Stanley
- Department of Psychological Medicine, King's College London, London, UK
| | - Nkasi Stoll
- Department of Psychological Medicine, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Rebecca D Rhead
- Department of Psychological Medicine, King's College London, London, UK
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Chilman N, Laporte D, Dorrington S, Hatch SL, Morgan C, Okoroji C, Stewart R, Das-Munshi J. Understanding social and clinical associations with unemployment for people with schizophrenia and bipolar disorders: large-scale health records study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02620-6. [PMID: 38378812 DOI: 10.1007/s00127-024-02620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE People with severe mental illness (SMI) experience high levels of unemployment. We aimed to better understand the associations between clinical, social, and demographic inequality indicators and unemployment. METHODS Data were extracted from de-identified health records of people with SMI in contact with secondary mental health services in south London, UK. A Natural Language Processing text-mining application was applied to extract information on unemployment in the health records. Multivariable logistic regression was used to assess associations with unemployment, in people with SMI. RESULTS Records from 19,768 service users were used for analysis, 84.9% (n = 16,778) had experienced unemployment. In fully adjusted models, Black Caribbean and Black African service users were more likely to experience unemployment compared with White British service users (Black Caribbean: aOR 1.62, 95% CI 1.45-1.80; Black African: 1.32, 1.15-1.51). Although men were more likely to have experienced unemployment relative to women in unadjusted models (OR 1.36, 95% CI 1.26-1.47), differences were no longer apparent in the fully adjusted models (aOR 1.05, 95% CI 0.97-1.15). The presence of a non-affective (compared to affective) diagnosis (1.24, 1.13-1.35), comorbid substance use (2.02, 1.76-2.33), previous inpatient admissions (4.18, 3.71-4.70), longer inpatient stays (78 + days: 7.78, 6.34-9.54), and compulsory admissions (3.45, 3.04-3.92) were associated with unemployment, in fully adjusted models. CONCLUSION People with SMI experience high levels of unemployment, and we found that unemployment was associated with several clinical and social factors. Interventions to address low employment may need to also address these broader inequalities.
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Affiliation(s)
- Natasha Chilman
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK.
- King's College London, ESRC Centre for Society and Mental Health, London, UK.
| | - Dionne Laporte
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK
- King's College London, ESRC Centre for Society and Mental Health, London, UK
- South London and Maudsley NHS Trust, London, UK
- NIHR Biomedical Research Centre, London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK
- King's College London, ESRC Centre for Society and Mental Health, London, UK
- NIHR Biomedical Research Centre, London, UK
| | - Craig Morgan
- King's College London, ESRC Centre for Society and Mental Health, London, UK
- NIHR Biomedical Research Centre, London, UK
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Celestin Okoroji
- Department of Psychological and Behavioural Science, London School of Economics, London, UK
- Black Thrive, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Trust, London, UK
- NIHR Biomedical Research Centre, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), East Wing 3.16, De Crespigny Park, London, SE5 8AF, UK
- King's College London, ESRC Centre for Society and Mental Health, London, UK
- South London and Maudsley NHS Trust, London, UK
- NIHR Biomedical Research Centre, London, UK
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3
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Yapp E, Booth T, Davis K, Coleman J, Howard LM, Breen G, Hatch SL, Hotopf M, Oram S. Sex differences in experiences of multiple traumas and mental health problems in the UK Biobank cohort. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1819-1831. [PMID: 33970300 PMCID: PMC10628045 DOI: 10.1007/s00127-021-02092-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/31/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Experiences of reported trauma are common and are associated with a range of mental health problems. Sex differences in how reported traumas are experienced over the life course in relation to mental health require further exploration. METHODS 157,358 participants contributed data for the UK Biobank Mental Health Questionnaire (MHQ). Stratified Latent Class Analysis (LCA) was used to analyse combinations of reported traumatic experiences in males and females separately, and associations with mental health. RESULTS In females, five trauma classes were identified: a low-risk class (58.6%), a childhood trauma class (13.5%), an intimate partner violence class (12.9%), a sexual violence class (9.1%), and a high-risk class (5.9%). In males, a three-class solution was preferred: a low-risk class (72.6%), a physical and emotional trauma class (21.9%), and a sexual violence class (5.5%). In comparison to the low-risk class in each sex, all trauma classes were associated with increased odds of current depression, anxiety, and hazardous/harmful alcohol use after adjustment for covariates. The high-risk class in females and the sexual violence class in males produced significantly increased odds for recent psychotic experiences. CONCLUSION There are sex differences in how reported traumatic experiences co-occur across a lifespan, with females at the greatest risk. However, reporting either sexual violence or multiple types of trauma was associated with increased odds of mental health problems for both males and females. Findings emphasise the public mental health importance of identifying and responding to both men and women's experiences of trauma, including sexual violence.
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Affiliation(s)
- Emma Yapp
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Tom Booth
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Katrina Davis
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, De Crespigny Park, Denmark Hill, London, UK
| | - Jonathan Coleman
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, De Crespigny Park, Denmark Hill, London, UK
| | - Louise M Howard
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, De Crespigny Park, Denmark Hill, London, UK
| | - Stephani L Hatch
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, De Crespigny Park, Denmark Hill, London, UK
| | - Siân Oram
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
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Catalao R, Zephyrin L, Richardson L, Coghill Y, Smylie J, Hatch SL. Tackling racism in maternal health. BMJ 2023; 383:e076092. [PMID: 37875287 DOI: 10.1136/bmj-2023-076092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Raquel Catalao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laurie Zephyrin
- Advancing Health Equity, Commonwealth Fund, New York, NY, USA
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, UNO Research and Technology Foundation, New Orleans, USA
| | - Yvonne Coghill
- Excellence in Action, Workforce Race Equality, NHS London, UK
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health, Toronto Canada
- Dalla Lana School of Public Health and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
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Liu Y, Hatch SL, Patalay P, Schott JM, Richards M. A lifecourse approach in examining the association between accumulation of adversity and mental health in older adulthood. J Affect Disord 2023; 339:211-218. [PMID: 37442442 DOI: 10.1016/j.jad.2023.07.001] [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: 02/28/2023] [Revised: 06/01/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND There is evidence for a cumulative effect of adversities on mental health, however, less is known on the accumulating duration of exposure to adversity across the lifecourse on mental health in older adults. METHODS Using data from the 1946 British birth cohort study (N = 2745), we examined associations between the accumulation of adversity (birth-63 years) and mental health (emotional symptom, life satisfaction, affective wellbeing) in older adults (63-69 years). Accumulation of adversity was assessed as the number of adversities and duration of exposure (number of lifecourse stages exposed to any, economic, psychosocial, or physical adversity). Linear regression tested their association with mental health, adjusted for sex, childhood cognition and emotional problems, and educational attainment. RESULTS Increased number of adversities was associated with increased emotional symptoms (β = 0.08 [0.06, 0.10]), decreased life satisfaction (β = -0.14 [-0.16, -0.12]) and decreased affective wellbeing (β = -0.08 [-0.10, -0.06]). Each additional duration of exposure was associated with a 0.38 [0.12, 0.65] standard deviation (SD) increase in emotional symptoms, and a - 0.68 [-0.96, -0.39] and -0.43 SD [-0.68, -0.18] decrease in life satisfaction and affective wellbeing, respectively. Life satisfaction showed stronger associations with economic and psychosocial compared to physical adversity. LIMITATIONS Some limitations include selective drop-out and lack of ethnic diversity. CONCLUSIONS Efforts to improve mental health in older adults should focus on reducing the number of adversities, as well as considering previous exposure across different lifecourse stages, to prevent adversities from becoming chronic. Future research should also consider the clustering and co-occurrence of different adversities across the lifecourse.
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Affiliation(s)
- Yiwen Liu
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Ronaldson A, de la Torre JA, Broadbent M, Ashworth M, Armstrong D, Bakolis I, Hatch SL, Hotopf M, Dregan A. Ethnic differences in physical and mental multimorbidity in working age adults with a history of depression and/or anxiety. Psychol Med 2023; 53:6212-6222. [PMID: 36420618 PMCID: PMC10520586 DOI: 10.1017/s0033291722003488] [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: 11/05/2021] [Revised: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current study used data from an ethnically diverse population from South London to examine ethnic differences in physical and mental multimorbidity among working age (18-64 years) adults in the context of depression and anxiety. METHOD The study included 44 506 patients who had previously attended Improving Access to Psychological Therapies services in the London Borough of Lambeth. Multinomial logistic regression examined cross-sectional associations between ethnicity with physical and mental multimorbidity. Patterns of multimorbidity were identified using hierarchical cluster analysis. RESULTS Within 44 056 working age adults with a history of depression or anxiety from South London there were notable ethnic differences in physical multimorbidity. Adults of Black Caribbean ethnicity were more likely to have physical multimorbidity [adjusted relative risk ratio (aRRR) = 1.25, 95% confidence interval (CI) 1.15-1.36] compared to adults of White ethnicity. Relative to adults of White ethnicity, adults of Asian ethnicity were more likely to have physical multimorbidity at higher thresholds only (e.g. 4 + conditions; aRRR = 1.53, 95% CI 1.17-2.00). Three physical (atopic, cardiometabolic, mixed) and three mental (alcohol/substance use, common/severe mental illnesses, personality disorder) multimorbidity clusters emerged. Ethnic minority groups with multimorbidity had a higher probability of belonging to the cardiometabolic cluster. CONCLUSION In an ethnically diverse population with a history of common mental health disorders, we found substantial between- and within-ethnicity variation in rates of physical, but not mental, multimorbidity. The findings emphasised the value of more granular definitions of ethnicity when examining the burden of physical and mental multimorbidity.
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Affiliation(s)
- Amy Ronaldson
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain
| | - Matthew Broadbent
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - David Armstrong
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Stephani L. Hatch
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Moreno-Agostino D, Fisher HL, Hatch SL, Morgan C, Ploubidis GB, Das-Munshi J. Generational, sex, and socioeconomic inequalities in mental and social wellbeing during the COVID-19 pandemic: prospective longitudinal observational study of five UK cohorts. Psychol Med 2023; 53:6403-6414. [PMID: 36345141 PMCID: PMC9874037 DOI: 10.1017/s0033291722003348] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research suggests that there have been inequalities in the impact of the coronavirus disease 2019 (COVID-19) pandemic and related non-pharmaceutical interventions on population mental health. We explored generational, sex, and socioeconomic inequalities during the first year of the pandemic using nationally representative cohorts from the UK. METHODS We analysed data from 26772 participants from five longitudinal cohorts representing generations born between 1946 and 2000, collected in May 2020, September-October 2020, and February-March 2021 across all five cohorts. We used a multilevel growth curve modelling approach to investigate generational, sex, and socioeconomic differences in levels of anxiety and depressive symptomatology, loneliness, and life satisfaction (LS) over time. RESULTS Younger generations had worse levels of mental and social wellbeing throughout the first year of the pandemic. Whereas these generational inequalities narrowed between the first and last observation periods for LS [-0.33 (95% CI -0.51 to -0.15)], they became larger for anxiety [0.22 (0.10, 0.33)]. Generational inequalities in depression and loneliness did not change between the first and last observation periods, but initial depression levels of the youngest cohort were worse than expected if the generational inequalities had not accelerated. Women and those experiencing financial difficulties had worse initial mental and social wellbeing levels than men and those financially living comfortably, respectively, and these gaps did not substantially differ between the first and last observation periods. CONCLUSIONS By March 2021, mental and social wellbeing inequalities persisted in the UK adult population. Pre-existing generational inequalities may have been exacerbated with the pandemic onset. Policies aimed at protecting vulnerable groups are needed.
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Affiliation(s)
- Darío Moreno-Agostino
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, 55-59 Gordon Square, London WC1H 0NU, UK
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
| | - Helen L. Fisher
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - Stephani L. Hatch
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
| | - George B. Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, 55-59 Gordon Square, London WC1H 0NU, UK
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London WC2B 4LL, UK
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK
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Stagg AL, Harber-Aschan L, Hatch SL, Fear NT, Dorrington S, Madan I, Stevelink SAM. Risk factors for the progression to multimorbidity among UK urban working-age adults. A community cohort study. PLoS One 2023; 18:e0291295. [PMID: 37682940 PMCID: PMC10490989 DOI: 10.1371/journal.pone.0291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person's quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and progression, with a focus on work participation. METHODS Data from 622 working-age adults who had completed two waves (baseline and follow-up) of the South-East London Community Health survey were analysed. Chi square tests and multinomial logistic regression were used to describe the associations between self-reported demographic, socioeconomic, psychosocial, and health-related variables, and the progression of LTCs. RESULTS Small social networks, an increased number of stressful life events, low self-rated health, functional impairment, and increased somatic symptom severity were all associated with both the progression from zero-to-one LTC and from one LTC to multimorbidity (two or more LTCs). Renting accommodation (RRR 1.73 [95% CI 1.03-2.90]), smoking (RRR 1.91 [95% CI 1.16-3.14]) and being overweight (RRR 1.88 [95% CL 1.12-3.16]) were unique risk factors of developing initial LTCs, whereas low income (RRR 2.53 [95% CI 1.11-5.80]), working part-time (RRR 2.82 ([95% CL 1.12-7.10]), being unemployed (RRR 4.83 [95% CI 1.69-13.84]), and making an early work exit (RRR 16.86 [95% CI 3.99-71.30]) all increased the risk of progressing from one LTC to multimorbidity compared to being employed full-time. At follow-up, depression was the most prevalent LTC in the unemployed group whereas musculoskeletal conditions were the most prevalent in those working. CONCLUSIONS The journey to multimorbidity is complex, with both common and unique risk factors. Non-full-time employment was associated with an increased risk of progression to multimorbidity. Future research should explore the risk and benefit pathways between employment and progression of LTCs. Interventions to prevent progression of LTCs should include mitigation of modifiable risk factors such as social isolation.
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Affiliation(s)
- Anne L. Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lisa Harber-Aschan
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ira Madan
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
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Ronaldson A, Stewart R, Mueller C, Das-Munshi J, Newbury JB, Mudway IS, Broadbent M, Fisher HL, Beevers S, Dajnak D, Hotopf M, Hatch SL, Bakolis I. Associations between air pollution and mental health service use in dementia: a retrospective cohort study. BMJ Ment Health 2023; 26:e300762. [PMID: 37550086 PMCID: PMC10577765 DOI: 10.1136/bmjment-2023-300762] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Little is known about the role of air pollution in how people with dementia use mental health services. OBJECTIVE We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia. METHODS In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models. FINDINGS In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function. CONCLUSIONS Residential air pollution exposure is associated with increased CMHT usage among people with dementia. CLINICAL IMPLICATIONS Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
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Affiliation(s)
- Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joanne B Newbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
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10
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Bakolis I, Murray ET, Hardy R, Hatch SL, Richards M. Area disadvantage and mental health over the life course: a 69-year prospective birth cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:735-744. [PMID: 36757437 PMCID: PMC10097760 DOI: 10.1007/s00127-023-02427-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Existing evidence on the mental health consequences of disadvantaged areas uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to investigate this association over a 69-year period. METHODS Data were obtained from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort), which consisted of 2125 participants at 69 years. We assessed longitudinal associations between area disadvantage and mental health symptoms at adolescence and adulthood with use of multilevel modelling framework. RESULTS After adjustment for father's social class, for each one percentage increase in area disadvantage at age 4, there was a 0.02 (95% CI 0.001, 0.04) mean increase in the total score of the neuroticism scale at age 13-15. After adjustment for father's social class, adult socio-economic position, cognitive ability and educational attainment, a one percentage increase in change score of area disadvantage between age 4 and 26 was associated with a mean increase in the total Psychiatric Symptom Frequency score (MD 0.06; 95% CI 0.007, 0.11). Similar associations were observed with change scores between ages 4, 53, 60 and total General Health Questionnaire-28 score at age 53 (MD 0.05; 95% CI 0.01, 0.11) and 60-64 (MD 0.06; 95% CI 0.009, 0.11). CONCLUSIONS Cohort members who experienced increasing area disadvantage from childhood were at increased risk of poor mental health over the life course. Population-wide interventions aiming at improving social and physical aspects of the early neighbourhood environment could reduce the socio-economic burden of poor mental health.
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Affiliation(s)
- Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Emily T Murray
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, IOPPN and South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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11
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Moreno-Agostino D, Fisher HL, Goodman A, Hatch SL, Morgan C, Richards M, Das-Munshi J, Ploubidis GB. Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study. PLoS Med 2023; 20:e1004145. [PMID: 37014820 PMCID: PMC10072377 DOI: 10.1371/journal.pmed.1004145] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/21/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex. METHODS AND FINDINGS We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire). We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach. The analytic sample included 16,389 participants. By September/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMDNSHD,pre-peak = -0.02 [-0.07, 0.04], SMDNCDS,pre-peak = 0.05 [0.02, 0.07], and SMDBCS70,pre-peak = 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiDNSHD,sex,pre-peak = 0.17 [0.06, 0.28], DiDNCDS,sex,pre-peak = 0.11 [0.07, 0.16], and DiDBCS70,sex,pre-peak = 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September/October 2020). As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK. CONCLUSIONS Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.
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Affiliation(s)
- Darío Moreno-Agostino
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
| | - Helen L. Fisher
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
- King’s College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Alissa Goodman
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, United Kingdom
| | - Stephani L. Hatch
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
- Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley NHS Trust, London, United Kingdom
| | - George B. Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, Melbourne House, London, United Kingdom
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Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
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Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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13
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Woodhead C, Onwumere J, Rhead R, Bora-White M, Chui Z, Clifford N, Connor L, Gunasinghe C, Harwood H, Meriez P, Mir G, Jones Nielsen J, Rafferty AM, Stanley N, Peprah D, Hatch SL. Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff. Ethn Health 2022; 27:1555-1574. [PMID: 34092149 PMCID: PMC7614854 DOI: 10.1080/13557858.2021.1936464] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULTS Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSIONS Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
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Affiliation(s)
- Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Clifford
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Meriez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Anne Marie Rafferty
- Department of Adult Nursing, Florence Nightingale Faculty for Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nathan Stanley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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14
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Ahmad G, McManus S, Cooper C, Hatch SL, Das-Munshi J. Prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England: repeated cross-sectional surveys of the general population in 2007 and 2014. Br J Psychiatry 2022; 221:520-527. [PMID: 35049474 DOI: 10.1192/bjp.2021.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Concerns persist that some ethnic minority groups experience longstanding mental health inequalities in England. It is unclear if these have changed over time. AIMS To assess the prevalence of common mental disorders (CMDs) and treatment receipt by ethnicity, and changes over time, using data from the nationally representative probability sample in the Adult Psychiatric Morbidity Surveys. METHOD We used survey data from 2007 (n = 7187) and 2014 (n = 7413). A Clinical Interview Schedule - Revised score of ≥12 indicated presence of a CMD. Treatment receipt included current antidepressant use; any counselling or therapy; seeing a general practitioner about mental health; or seeing a community psychiatrist, psychologist or psychiatric nurse, in the past 12 months. Multivariable logistic regression assessed CMD prevalence and treatment receipt by ethnicity. RESULTS CMD prevalence was highest in the Black group; ethnic variation was explained by demographic and socioeconomic factors. After adjustment for these factors and CMDs, odds ratios for treatment receipt were lower for the Asian (0.62, 95% CI 0.39-1.00) and White Other (0.58, 95% CI 0.38-0.87) groups in 2014, compared with the White British group; for the Black group, this inequality appeared to be widening over time (2007 treatment receipt odds ratio 0.68, 95% CI 0.38-1.23; 2014 treatment receipt odds ratio 0.23, 95% CI 0.13-0.40; survey year interaction P < 0.0001). CONCLUSIONS Treatment receipt was lower for all ethnic minority groups compared with the White British group, and lowest among Black people, for whom inequalities appear to be widening over time. Addressing socioeconomic inequality could reduce ethnic inequalities in mental health problems, but this does not explain pronounced treatment inequalities.
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Affiliation(s)
- Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, and National Centre for Social Research, UK
| | - Claudia Cooper
- Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Stephani L Hatch
- ESRC Centre for Society and Mental Health, King's College London, UK
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King's College London, UK
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15
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Gauci AA, Attoe C, Woodhead C, Hatch SL, Kainth R. The influence of patient gender in healthcare professional decision-making: an interaction analysis of simulation debriefings. Simul Healthc 2022. [DOI: 10.54531/iivd1435] [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: 11/20/2022]
Abstract
Previous research suggests that gender bias is pervasive in health care and has deleterious effects on treatment outcomes for patients. When developing and improving training on gender bias, we need to further our understanding of how such topics arise and are sustained in conversations between healthcare professionals (HCPs). The aim of this study is to analyze the influence of patient gender in HCP decision-making by analyzing how they surface, discuss and manage topics around gender.
An ethnomethodological qualitative study using discursive psychology and conversation analysis was implemented to examine 10 simulation debriefs in a specialized mental healthcare simulation centre in London. Video footage was obtained from mental health simulation training courses on bias in clinical decision-making, involving HCPs from mixed healthcare professions. Following transcription of selected segments, the debriefs were analyzed and repeated patterns of interaction were captured in distinct themes.
Four main themes were identified from the data, indicating some of the ways in which conversations about gender are managed: collaboration (to encourage discussion), surprise (when unexpected topics arose), laughter (to diffuse tense situations) and silence (demonstrating careful thinking). Patients with mental health conditions were perceived differently in terms of treatment decisions due to existing gender biases.
The persistence of gender bias that may result in discrimination in health care with negative consequences attests to the need for greater awareness and training development at various levels to include an intersectional approach.
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Affiliation(s)
- Andrea Amato Gauci
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Chris Attoe
- ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Charlotte Woodhead
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ranjev Kainth
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Ronaldson A, Arias de la Torre J, Gaughran F, Bakolis I, Hatch SL, Hotopf M, Dregan A. Prospective associations between vitamin D and depression in middle-aged adults: findings from the UK Biobank cohort. Psychol Med 2022; 52:1866-1874. [PMID: 33081855 PMCID: PMC9340850 DOI: 10.1017/s0033291720003657] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND A possible role of vitamin D in the pathophysiology of depression is currently speculative, with more rigorous research needed to assess this association in large adult populations. The current study assesses prospective associations between vitamin D status and depression in middle-aged adults enrolled in the UK Biobank. METHODS We assessed prospective associations between vitamin D status at the baseline assessment (2006-2010) and depression measured at the follow-up assessment (2016) in 139 128 adults registered with the UK Biobank. RESULTS Amongst participants with no depression at baseline (n = 127 244), logistic regression revealed that those with vitamin D insufficiency [adjusted odds ratio (aOR) = 1.14, 95% confidence interval (CI) = 1.07-1.22] and those with vitamin D deficiency (aOR = 1.24, 95% CI 1.13-1.36) were more likely to develop new-onset depression at follow-up compared with those with optimal vitamin D levels after adjustment for a wide range of relevant covariates. Similar prospective associations were reported for those with depression at baseline (n = 11 884) (insufficiency: aOR = 1.11, 95% CI 1.00-1.23; deficiency: aOR = 1.30, 95% CI 1.13-1.50). CONCLUSIONS The prospective associations found between vitamin D status and depression suggest that both vitamin D deficiency and insufficiency might be risk factors for the development of new-onset depression in middle-aged adults. Moreover, vitamin D deficiency (and to a lesser extent insufficiency) might be a predictor of sustained depressive symptoms in those who are already depressed. Vitamin D deficiency and insufficiency is very common, meaning that these findings have significant implications for public health.
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Affiliation(s)
- Amy Ronaldson
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Stephani L. Hatch
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandru Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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17
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Parsons V, Juszczyk D, Gilworth G, Ntani G, Henderson M, Smedley J, McCrone P, Hatch SL, Shannon R, Coggon D, Molokhia M, Griffiths A, Walker-Bone K, Madan I. Developing and testing a case-management intervention to support the return to work of health care workers with common mental health disorders. J Public Health (Oxf) 2022:6594717. [PMID: 35640243 DOI: 10.1093/pubmed/fdac055] [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: 08/10/2021] [Revised: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). METHODS A mixed methods feasibility study. RESULTS Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. CONCLUSIONS The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.
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Affiliation(s)
- V Parsons
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK.,Faculty of Life Sciences & Medicine, King's College London, London SE1 9NH, UK
| | - D Juszczyk
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK
| | - G Gilworth
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK
| | - G Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK
| | - M Henderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - J Smedley
- Occupational Health, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - P McCrone
- King's Health Economics, King's College London, London SE1 9NH, UK.,Faculty of Education, Health & Human Sciences School of Health Sciences University of Greenwich, King's College London, London SE19NH, UK
| | - S L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London SE5 8AF, UK
| | - R Shannon
- School of Health Sciences, University of Southampton, Southampton SO14 0YN, UK
| | - D Coggon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK
| | - M Molokhia
- Department of Population Health Sciences, School of Life Course and Population Sciences, Population Health Sciences, King's College London, London SE1 1UL, UK
| | - A Griffiths
- Mental Health & Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham NG7 2UH(UK), UK
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton SO16 6YD, UK
| | - I Madan
- Occupational Health Service, Guy's & St Thomas' NHS Foundation Trust, London SE1 7NJ, UK.,Faculty of Life Sciences & Medicine, King's College London, London SE1 9NH, UK
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18
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Dorrington S, Carr E, Stevelink SAM, Dregan A, Woodhead C, Das-Munshi J, Ashworth M, Broadbent M, Madan I, Hatch SL, Hotopf M. Multimorbidity and fit note receipt in working-age adults with long-term health conditions. Psychol Med 2022; 52:1156-1165. [PMID: 32895068 DOI: 10.1017/s0033291720002937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. METHODS Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. RESULTS We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). CONCLUSIONS Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
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Affiliation(s)
- Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Charlotte Woodhead
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London SE1 1UL, UK
| | | | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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19
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Ahmad G, McManus S, Bécares L, Hatch SL, Das-Munshi J. Explaining ethnic variations in adolescent mental health: a secondary analysis of the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:817-828. [PMID: 34689228 PMCID: PMC8541880 DOI: 10.1007/s00127-021-02167-w#sec9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2023]
Abstract
PURPOSE The relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study. METHODS Parental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixed n = 492, Indian n = 275, Pakistani n = 496, Bangladeshi n = 221, Black Caribbean n = 102, Black African n = 187, Other Ethnic Group n = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use). Results were stratified by sex as evidence of a sex/ethnicity interaction was found (P = 0.0002). RESULTS There were lower unadjusted odds for mental health problems in boys from Black African (OR 0.15, 95% CI 0.04-0.61) and Indian backgrounds (OR 0.42, 95% CI 0.21-0.86) compared to White peers. After adjustment for income, odds were lower in boys from Black African (OR 0.10, 95% CI 0.02-0.38), Indian (OR 0.40, 95% CI 0.21-0.77), and Pakistani (OR 0.49, 95% CI 0.27-0.89) backgrounds, and girls from Bangladeshi (OR 0.18, 95% CI 0.05-0.65) and Pakistani (OR 0.63, 95% CI 0.41-0.99) backgrounds. After further adjustment for social support, participation, and adversity factors, only boys from a Black African background had lower odds (OR 0.16, 95% CI 0.03-0.71) of mental health problems. CONCLUSIONS Household income confounded lower prevalence of mental health problems in some young people from Pakistani and Bangladeshi backgrounds; findings suggest ethnic differences are partly but not fully accounted for by income, social support, participation, and adversity. Addressing income inequalities and socially focused interventions may protect against mental health problems irrespective of ethnicity.
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Affiliation(s)
- Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Sally McManus
- Violence and Society Centre, City, University of London, and National Centre for Social Research, London, UK
| | - Laia Bécares
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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20
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Abstract
BACKGROUND There is a knowledge gap about the experiences that affect the mental health of Black university students in the UK. Current research is focused on understanding the continuation, attainment and progression gap between Black students and non-Black students. It is essential to know more about the interactions between personal and institutional factors on the mental health of Black students to explain the inequalities in their experiences and outcomes across the university lifecycle. The current study set out to thematically synthesise articles that explore the experiences that affect the mental health and mental well-being of Black university students in the UK. METHODS This study is a qualitative thematic synthesis of a literature review. We developed search strategies for four online databases (PubMed, Social Science Premium Collection via ProQuest, Open Access Theses and Dissertations, and Open Grey) covering January 2010 to July 2020. This search was combined with a manual search of reference lists and related citations. All articles in English addressing mental health and mental well-being experiences among Black university students studying at a UK university were included. Critical Appraisal Skills Programme Checklist was used to assess bias. A thematic synthesis was conducted using Braun and Clarke (2006)'s six-step guide to develop descriptive themes and analytical constructs. RESULTS Twelve articles were included. Several themes were identified as affecting the mental health of Black university students in the UK: academic pressure, learning environment, Black gendered experience, isolation and alienation, culture shock, racism and support. DISCUSSION This review provides an appraisal of the factors affecting the mental health and mental well-being of Black students at UK universities, which need to be addressed by higher education policy-makers and key decision-makers. Further research is needed about the mental health experiences of Black university students in relation to Black identities, suicidality, mental health language, the physical environment, and racism and other institutional factors.
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Affiliation(s)
- Nkasi Stoll
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Yannick Yalipende
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Nicola C Byrom
- Department of Psychology, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Heidi Lempp
- Department of Inflammation Biology, King's College London Faculty of Life Sciences and Medicine, London, UK
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21
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Knowles G, Gayer‐Anderson C, Turner A, Dorn L, Lam J, Davis S, Blakey R, Lowis K, Pinfold V, Creary N, Dyer J, Hatch SL, Ploubidis G, Bhui K, Harding S, Morgan C. Covid-19, social restrictions, and mental distress among young people: a UK longitudinal, population-based study. J Child Psychol Psychiatry 2022; 63:1392-1404. [PMID: 35199336 PMCID: PMC9114888 DOI: 10.1111/jcpp.13586] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adolescence is a critical period for social and emotional development. We sought to examine the impacts of Covid-19 and related social restrictions and school closures on adolescent mental health, particularly among disadvantaged, marginalised, and vulnerable groups. METHODS We analysed four waves of data - 3 pre-Covid-19 (2016-2019) and 1 mid-Covid-19 (May-Aug 2020; n, 1074; 12-18 years old, >80% minority ethnic groups, 25% free school meals) from REACH (Resilience, Ethnicity, and AdolesCent Mental Health), an adolescent cohort based in inner-London, United Kingdom. Mental health was assessed using validated measures at each time point. We estimated temporal trends in mental distress and examined variations in changes in distress, pre- to mid-Covid-19, by social group, and by pre- and mid-pandemic risks. RESULTS We found no evidence of an overall increase in mental distress midpandemic (15.9%, 95% CI: 13.0, 19.4) compared with prepandemic (around 18%). However, there were variations in changes in mental distress by subgroups. There were modest variations by social group and by pre-Covid risks (e.g., a small increase in distress among girls (b [unstandardised beta coefficient] 0.42 [-0.19, 1.03]); a small decrease among boys (b - 0.59 [-1.37, 0.19]); p for interaction .007). The most notable variations were by midpandemic risks: that is, broadly, increases in distress among those reporting negative circumstances and impacts (e.g., in finances, housing, social support and relationships, and daily routines) and decreases in distress among those reporting positive impacts. CONCLUSIONS We found strong evidence that mental distress increased among young people who were most negatively impacted by Covid-19 and by related social restrictions during the first lockdown in the United Kingdom.
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Affiliation(s)
- Gemma Knowles
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Charlotte Gayer‐Anderson
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Alice Turner
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Lynsey Dorn
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Joseph Lam
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Samantha Davis
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Rachel Blakey
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Katie Lowis
- ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | | | | | | | | | | | - Stephani L. Hatch
- ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK,Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - George Ploubidis
- Centre for Longitudinal StudiesUniversity College LondonLondonUK
| | | | - Seeromanie Harding
- Department of Nutritional SciencesSchool of Life Course SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Craig Morgan
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
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22
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Stoll N, Yalipende Y, Arday J, Smithies D, Byrom NC, Lempp H, Hatch SL. Protocol for black student well-being study: a multi-site qualitative study on the mental health and well-being experiences of black UK university students. BMJ Open 2022; 12:e051818. [PMID: 35140150 PMCID: PMC8830255 DOI: 10.1136/bmjopen-2021-051818] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is an increasing concern about the mental health and mental well-being of university students in the UK. Black university students who report a mental health condition are less likely to complete their course, achieve a first-class or upper second-class degree and progress to further education. This study will document black university students' accounts of their mental health experiences and perceptions of key turning points of biographical changes to their mental health as they move through the university life cycle. METHODS AND ANALYSIS This is a qualitative study. Data will be collected through a biographical narrative interpretive method. Interviews will enable the researcher to study systematically how participants make sense of themselves and account for the complexities of their life experiences, from their own perspectives and language. An interpretative phenomenological approach will be used to offer insights into what black students studying at UK universities report affects their mental health and well-being. Data collection for this study commenced in October 2020. Data collection and analyses will be completed by January 2022. ETHICS AND DISSEMINATION Full ethical approval for the current study was obtained from King's College London Psychiatry, Nursing and Midwifery Research Ethics Subcommittee (Rec Ref: 20489, Project Ref: HR-19/20-20489, 2 October 2020). From the study findings, we aim to contribute to the evidence base, make recommendations for interventions and encourage further study into black student mental health.
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Affiliation(s)
- Nkasi Stoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre For Society and Mental Health, King's College London, London, UK
| | - Yannick Yalipende
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jason Arday
- Department of Sociology and Social Policy, University of Durham, Durham, UK
| | | | - Nicola C Byrom
- Department of Psychology, King's College London, London, UK
| | - Heidi Lempp
- Inflammation Biology, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre For Society and Mental Health, King's College London, London, UK
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23
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Woodhead C, Stoll N, Harwood H, Alexis O, Hatch SL. "They created a team of almost entirely the people who work and are like them": A qualitative study of organisational culture and racialised inequalities among healthcare staff. Sociol Health Illn 2022; 44:267-289. [PMID: 34866199 PMCID: PMC7614856 DOI: 10.1111/1467-9566.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/06/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
Racially and ethnically minoritised healthcare staff groups disproportionately experience and witness workplace discrimination from patients, colleagues and managers. This is visible in their under-representation at senior levels and over-representation in disciplinary proceedings and is associated with adversities such as greater depression, anxiety, somatic symptoms, low job satisfaction and sickness absence. In the UK, little progress has been made despite the implementation of measures to tackle racialised inequities in the health services. So, what is it about the health service organisational context which shapes and maintains such inequities, and what role does discrimination, bullying and harassment play? Drawing on qualitative interviews with 48 healthcare staff in London (UK), we identify how micro-level bullying, prejudice, discrimination and harassment behaviours, independently and in combination, exploit and maintain meso-level racialised hierarchies. Within teams, the high diversity-low inclusion dynamic shaped and was perpetuated by in- and outgroup inclusion and exclusion processes (including "insidious dismissal") often employing bullying or microaggressions. These were linked to intersecting factors, such as race, ethnicity, migration, language and religion, and could increase segregation. For racially and ethnically minoritised groups, ingroup maintenance, moving teams or leaving were also ways of coping with organisational inequities. We discuss implications for tackling racialised workplace inequities.
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Affiliation(s)
- Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Nkasi Stoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Obrey Alexis
- Department of Nursing, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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24
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Ahmad G, McManus S, Bécares L, Hatch SL, Das-Munshi J. Explaining ethnic variations in adolescent mental health: a secondary analysis of the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:817-828. [PMID: 34689228 PMCID: PMC8541880 DOI: 10.1007/s00127-021-02167-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study. METHODS Parental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixed n = 492, Indian n = 275, Pakistani n = 496, Bangladeshi n = 221, Black Caribbean n = 102, Black African n = 187, Other Ethnic Group n = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use). Results were stratified by sex as evidence of a sex/ethnicity interaction was found (P = 0.0002). RESULTS There were lower unadjusted odds for mental health problems in boys from Black African (OR 0.15, 95% CI 0.04-0.61) and Indian backgrounds (OR 0.42, 95% CI 0.21-0.86) compared to White peers. After adjustment for income, odds were lower in boys from Black African (OR 0.10, 95% CI 0.02-0.38), Indian (OR 0.40, 95% CI 0.21-0.77), and Pakistani (OR 0.49, 95% CI 0.27-0.89) backgrounds, and girls from Bangladeshi (OR 0.18, 95% CI 0.05-0.65) and Pakistani (OR 0.63, 95% CI 0.41-0.99) backgrounds. After further adjustment for social support, participation, and adversity factors, only boys from a Black African background had lower odds (OR 0.16, 95% CI 0.03-0.71) of mental health problems. CONCLUSIONS Household income confounded lower prevalence of mental health problems in some young people from Pakistani and Bangladeshi backgrounds; findings suggest ethnic differences are partly but not fully accounted for by income, social support, participation, and adversity. Addressing income inequalities and socially focused interventions may protect against mental health problems irrespective of ethnicity.
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Affiliation(s)
- Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Sally McManus
- Violence and Society Centre, City, University of London, and National Centre for Social Research, London, UK
| | - Laia Bécares
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
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25
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Rhead RD, Woodhead C, Ahmad G, Das-Munshi J, McManus S, Hatch SL. A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2049-2063. [PMID: 35254450 PMCID: PMC9477952 DOI: 10.1007/s00127-022-02259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014-2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45-2.02), economically inactive (AOR 2.02, 95% CI:1.05-3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02-1.74), and Black (AOR 0.36 95% CI:0.20-0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group ("White British, highly educated, employed, high social class"), "Retired White British" had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while "Employed migrants" had lower odds (AOR 0.39, 95% CI:0.27-0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but-except for sexual minorities-adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.
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Affiliation(s)
- Rebecca D. Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,South London and Maudsley (SLaM) NHS Trust, London, UK
| | - Sally McManus
- National Centre for Social Research, London, UK ,Violence and Society Centre, City, University of London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
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Newbury JB, Stewart R, Fisher HL, Beevers S, Dajnak D, Broadbent M, Pritchard M, Shiode N, Heslin M, Hammoud R, Hotopf M, Hatch SL, Mudway IS, Bakolis I. Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: retrospective cohort study. Br J Psychiatry 2021; 219:678-685. [PMID: 35048872 PMCID: PMC8636613 DOI: 10.1192/bjp.2021.119] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND Growing evidence suggests that air pollution exposure may adversely affect the brain and increase risk for psychiatric disorders such as schizophrenia and depression. However, little is known about the potential role of air pollution in severity and relapse following illness onset. AIMS To examine the longitudinal association between residential air pollution exposure and mental health service use (an indicator of illness severity and relapse) among individuals with first presentations of psychotic and mood disorders. METHOD We identified individuals aged ≥15 years who had first contact with the South London and Maudsley NHS Foundation Trust for psychotic and mood disorders in 2008-2012 (n = 13 887). High-resolution (20 × 20 m) estimates of nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. In-patient days and community mental health service (CMHS) events were recorded over 1-year and 7-year follow-up periods. RESULTS Following covariate adjustment, interquartile range increases in NO2, NOx and PM2.5 were associated with 18% (95% CI 5-34%), 18% (95% CI 5-34%) and 11% (95% CI 3-19%) increased risk for in-patient days after 1 year. Similarly, interquartile range increases in NO2, NOx, PM2.5 and PM10 were associated with 32% (95% CI 25-38%), 31% (95% CI 24-37%), 7% (95% CI 4-11%) and 9% (95% CI 5-14%) increased risk for CMHS events after 1 year. Associations persisted after 7 years. CONCLUSIONS Residential air pollution exposure is associated with increased mental health service use among people recently diagnosed with psychotic and mood disorders. Assuming causality, interventions to reduce air pollution exposure could improve mental health prognoses and reduce healthcare costs.
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Affiliation(s)
- Joanne B. Newbury
- Centre for Academic Mental Health and MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol; and King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Robert Stewart
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L. Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Sean Beevers
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London; and MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, UK
| | - David Dajnak
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London; and MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, UK
| | - Matthew Broadbent
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London; and NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Pritchard
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London; and NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Margaret Heslin
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ryan Hammoud
- King's College London, Department of Psychosis Studies, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Hotopf
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L. Hatch
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Ian S. Mudway
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London; and MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London; and NIHR Health Protection Research Unit in Environmental Exposures and Health, School of Public Health, Faculty of Medicine, Imperial College London, UK
| | - Ioannis Bakolis
- King's College London, Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London; and King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, London, UK,Correspondence: Ioannis Bakolis.
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Arias-de la Torre J, Ronaldson A, Prina M, Matcham F, Pinto Pereira SM, Hatch SL, Armstrong D, Pickles A, Hotopf M, Dregan A. Depressive symptoms during early adulthood and the development of physical multimorbidity in the UK: an observational cohort study. Lancet Healthy Longev 2021; 2:e801-e810. [PMID: 34901908 PMCID: PMC8636278 DOI: 10.1016/s2666-7568(21)00259-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An understanding of whether early-life depression is associated with physical multimorbidity could be instrumental for the development of preventive measures and the integrated management of depression. We therefore aimed to map out the cumulative incidence of physical multimorbidity over adulthood, and to determine the association between the presence of depressive symptoms during early adulthood and the development of physical multimorbidity in middle age. METHODS In this observational cohort study, we used pooled data from the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS). Cohort waves were pooled in each decade of adult life available (when cohort members were aged 26 years in the BCS and 23 years in the NCDS [baseline]; 34 years in the BCS and 33 years in the NCDS [age 34 BCS/33 NCDS]; 42 years in the BCS and NCDS [age 42 BCS/NCDS]; and 46 years in the BCS and 50 years in the NCDS [age 46 BCS/50 NCDS]). We included participants who had completed the nine-item Malaise Inventory at baseline, and did not have a history of physical multimorbidity, any physical multimorbidity at baseline, or the presence of depressive symptoms before the development of physical multimorbidity. The presence of depressive symptoms was determined using the nine-item Malaise Inventory (cutoff score ≥4). Physical multimorbidity was defined as having at least two measures of any of the following ten self-reported groups of long-term conditions: asthma or bronchitis; backache; bladder or kidney conditions; cancer; cardiovascular conditions; convulsions or epilepsy; diabetes; hearing conditions; migraine; and stomach, bowel, or gall conditions. Cumulative incidence (with 95% CI) of physical multimorbidity was calculated for each decade considered after baseline, with physical multimorbidity being assessed as both a dichotomous and categorical variable. The association between depressive symptoms and the development of physical multimorbidity was assessed using adjusted relative risk ratios (with 95% CIs). FINDINGS Analyses included 15 845 participants, of whom 4001 (25·25%; 95% CI 24·57-25·93) had depressive symptoms at baseline and 11 844 (74·75%; 74·07-75·42) did not. The cumulative incidence of physical multimorbidity (dichotomous) ranged over the study period from 2263 (18·44%; 95% CI 17·75-18·14) of 12 273 participants at age 34 BCS/33 NCDS, to 4496 (42·90%; 41·95-43·85) of 10 481 participants at age 46 BCS/50 NCDS, and was consistently higher in participants with depressive symptoms at baseline. The adjusted relative risk of physical multimorbidity was higher in participants with depressive symptoms than in those without and remained stable over the study period (adjusted relative rate ratio 1·67, 95% CI 1·50-1·87, at age 34 BCS/33 NCDS; 1·63, 1·48-1·79, at age 42 BCS/NCDS; and 1·58, 1·43-1·73, at age 46 BCS/50 NCDS). INTERPRETATION The presence of depressive symptoms during early adulthood is associated with an increased risk of the development of physical multimorbidity in middle age. Although further research about the drivers of this relationship is needed, these results could help to enhance the integrated management of individuals with depressive symptoms and the development of preventive strategies to reduce the effect and burden of physical multimorbidity. FUNDING UK Medical Research Council and Guy's Charity.
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Affiliation(s)
- Jorge Arias-de la Torre
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute of Biomedicine, University of Leon, Leon, Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Prina
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Snehal M Pinto Pereira
- Institute of Sport, Exercise and Health, Faculty of Medical Sciences, University College London, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - David Armstrong
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Das-Munshi J, Chang CK, Dregan A, Hatch SL, Morgan C, Thornicroft G, Stewart R, Hotopf M. How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK. Psychol Med 2021; 51:2581-2589. [PMID: 32372741 PMCID: PMC8579155 DOI: 10.1017/s0033291720001087] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Across international contexts, people with serious mental illnesses (SMI) experience marked reductions in life expectancy at birth. The intersection of ethnicity and social deprivation on life expectancy in SMI is unclear. The aim of this study was to assess the impact of ethnicity and area-level deprivation on life expectancy at birth in SMI, defined as schizophrenia-spectrum disorders, bipolar disorders and depression, using data from London, UK. METHODS Abridged life tables to calculate life expectancy at birth, in a cohort with clinician-ascribed ICD-10 schizophrenia-spectrum disorders, bipolar disorders or depression, managed in secondary mental healthcare. Life expectancy in the study population with SMI was compared with life expectancy in the general population and with those residing in the most deprived areas in England. RESULTS Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Similar reductions were noted for people with depression. Across all diagnoses, life expectancy at birth in people with SMI was lower than the general population residing in the most deprived areas in England. CONCLUSIONS Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England. This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account.
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Affiliation(s)
- Jayati Das-Munshi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | | | - Alex Dregan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L. Hatch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, UK
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Trust, London, UK
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Bakolis I, Hammoud R, Stewart R, Beevers S, Dajnak D, MacCrimmon S, Broadbent M, Pritchard M, Shiode N, Fecht D, Gulliver J, Hotopf M, Hatch SL, Mudway IS. Mental health consequences of urban air pollution: prospective population-based longitudinal survey. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1587-1599. [PMID: 33097984 PMCID: PMC7584487 DOI: 10.1007/s00127-020-01966-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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] [Received: 12/04/2019] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health. METHODS A prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO2) and oxides (NOx), ozone (O3), particulate matter with an aerodynamic diameter < 10 μm (PM10) and < 2.5 μm (PM2.5) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals' socioeconomic position and exposure to road-traffic noise. RESULTS We found robust evidence for interquartile range increases in PM2.5, NOx and NO2 to be associated with 18-39% increased odds of common mental disorders, 19-30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM10. These longitudinal associations were more pronounced in the subset of non-movers for NO2 and NOx. CONCLUSIONS The findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.
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Affiliation(s)
- Ioannis Bakolis
- Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Broadbent
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Megan Pritchard
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | | | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- Centre for Environmental Health and Sustainability, School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit on Environmental Exposures and Health, Imperial College London, London, UK
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Pierce M, McManus S, Hope H, Hotopf M, Ford T, Hatch SL, John A, Kontopantelis E, Webb RT, Wessely S, Abel KM. Mental health responses to the COVID-19 pandemic: a latent class trajectory analysis using longitudinal UK data. Lancet Psychiatry 2021; 8:610-619. [PMID: 33965057 PMCID: PMC9764381 DOI: 10.1016/s2215-0366(21)00151-6] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The mental health of the UK population declined at the onset of the COVID-19 pandemic. Convenience sample surveys indicate that recovery began soon after. Using a probability sample, we tracked mental health during the pandemic to characterise mental health trajectories and identify predictors of deterioration. METHODS This study was a secondary analysis of five waves of the UK Household Longitudinal Study (a large, national, probability-based survey that has been collecting data continuously since January, 2009) from late April to early October, 2020 and pre-pandemic data taken from 2018-19. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). We used latent class mixed models to identify discrete mental health trajectories and fixed-effects regression to identify predictors of change in mental health. FINDINGS Mental health was assessed in 19 763 adults (≥16 years; 11 477 [58·1%] women and 8287 [41·9%] men; 3453 [17·5%] participants from minority ethnic groups). Mean population mental health deteriorated with the onset of the pandemic and did not begin improving until July, 2020. Latent class analysis identified five distinct mental health trajectories up to October 2020. Most individuals in the population had either consistently good (7437 [39·3%] participants) or consistently very good (7623 [37·5%] participants) mental health across the first 6 months of the pandemic. A recovering group (1727 [12·0%] participants) showed worsened mental health during the initial shock of the pandemic and then returned to around pre-pandemic levels of mental health by October, 2020. The two remaining groups were characterised by poor mental health throughout the observation period; for one group, (523 [4·1%] participants) there was an initial worsening in mental health that was sustained with highly elevated scores. The other group (1011 [7·0%] participants) had little initial acute deterioration in their mental health, but reported a steady and sustained decline in mental health over time. These last two groups were more likely to have pre-existing mental or physical ill-health, to live in deprived neighbourhoods, and be of Asian, Black or mixed ethnicity. Infection with SARS-CoV-2, local lockdown, and financial difficulties all predicted a subsequent deterioration in mental health. INTERPRETATION Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels. Around one in nine individuals had deteriorating or consistently poor mental health. People living in areas affected by lockdown, struggling financially, with pre-existing conditions, or infection with SARS-CoV-2 might benefit most from early intervention. FUNDING None.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Sally McManus
- National Centre for Social Research, London, UK; Violence and Society Centre, City, University of London, London, UK
| | - Holly Hope
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Roger T Webb
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Faculty of Biology, Medicine and Health Sciences, and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Powell TR, Hotopf M, Hatch SL, Breen G, Duarte RRR, Nixon DF. Genetic risk for severe COVID-19 correlates with lower inflammatory marker levels in a SARS-CoV-2-negative cohort. Clin Transl Immunology 2021; 10:e1292. [PMID: 34141432 PMCID: PMC8180242 DOI: 10.1002/cti2.1292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives It remains unknown how inflammatory marker levels differ amongst individuals susceptible to coronavirus disease 2019 (COVID-19), prior to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the onset of the cytokine storm. We used genetic risk scores to model how susceptibility to severe COVID-19 correlates with baseline levels of 35 inflammatory markers, by testing their impact in a SARS-CoV-2-negative population cohort. Because of the established effects of age and body mass index on severe COVID-19 risk, we further considered how these variables interacted with genetic risk to affect inflammatory marker levels. Methods We accessed data on 406 SARS-CoV-2-negative individuals as part of a UK population study. Multiplex electrochemiluminescence methods were applied to blood serum, and 35 inflammatory markers were assayed. Corresponding genotype data, alongside results from a large genome-wide association study of severe COVID-19, allowed us to construct genetic risk scores and to test their impact on inflammatory protein levels. Results Our results revealed that a higher genetic risk for severe COVID-19 was associated with lower blood levels of interferon gamma (IFN-γ), vascular endothelial growth factor D (VEGF-D) and tumor necrosis factor alpha (TNF-α). Inflammatory profiles of those with high genetic risk increasingly diverge from the norm in association with age and obesity. Conclusion Our results support the theory that individuals at risk of severe COVID-19 have a deficient innate immunity marked by reduced levels of inflammatory markers at baseline, including IFN-γ, VEGF-D and TNF-α. We hypothesise that a secondary overactive adaptive immune response may subsequently explain the high levels of cytokines observed in SARS-CoV-2-positive COVID-19 patients.
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Affiliation(s)
- Timothy R Powell
- Division of Infectious Diseases Department of Medicine Weill Cornell Medicine New York NY USA.,Social, Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Matthew Hotopf
- Department of Psychological Medicine Institute of Psychiatry, Psychology & Neuroscience King's College London London UK.,South London and Maudsley NHS Foundation Trust London UK
| | - Stephani L Hatch
- Department of Psychological Medicine Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Rodrigo R R Duarte
- Division of Infectious Diseases Department of Medicine Weill Cornell Medicine New York NY USA.,Social, Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Douglas F Nixon
- Division of Infectious Diseases Department of Medicine Weill Cornell Medicine New York NY USA
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Arias de la Torre J, Ronaldson A, Valderas JM, Vilagut G, Serrano-Blanco A, Hatch SL, Alonso J, Hotopf M, Dregan A. Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health. Br J Psychiatry 2021; 218:237-239. [PMID: 33436108 DOI: 10.1192/bjp.2020.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Mental health-related multimorbidity can be considered as multimorbidity in the presence of a mental disorder. Some knowledge gaps on the study of mental health-related multimorbidity were identified. These knowledge gaps could be potentially addressed with real-world data.
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Affiliation(s)
- Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; and Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, UK
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Spain; and Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Spain
| | - Antoni Serrano-Blanco
- Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Spain; and Sant Joan de Déu Research Institute, Parc Sanitari Sant Joan de Déu, Spain
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Jordi Alonso
- Hospital del Mar Medical Research Institute (IMIM), Spain; and Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Spain
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; and South London and Maudsley NHS Foundation Trust, UK
| | - Alexandru Dregan
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK
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Palmos AB, Chung R, Frissa S, Goodwin L, Hotopf M, Hatch SL, Breen G, Powell TR. Reconsidering the reasons for heightened inflammation in major depressive disorder. J Affect Disord 2021; 282:434-441. [PMID: 33422819 DOI: 10.1016/j.jad.2020.12.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/25/2020] [Revised: 11/03/2020] [Accepted: 12/24/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increased circulating pro-inflammatory markers have repeatedly been associated with major depressive disorder (MDD). However, it remains unclear whether inflammation represents a causal mechanism for MDD, or whether the association is influenced by confounding factors such as body mass index (BMI). METHODS To better understand this complex relationship, we generated polygenic risk scores (PRS) for MDD and BMI in a population cohort and attempted to isolate the impact these potential risk factors have on adulthood inflammation. Peripheral blood samples were collected as part of the South East London Community Health study, where we generated individualized PRS for MDD and BMI and quantified inflammatory markers using multiplex ELISA-based technology. We performed linear regressions to investigate the effects of PRS for MDD and BMI on inflammatory marker levels. RESULTS Out of 35 inflammatory markers, we found a nominal effect of PRS for MDD on interleukin-10. We also found a significant positive effect of BMI on nine inflammatory markers, of which the two most strongly affected markers, interleukin-6 (IL-6) and C-reactive protein (CRP), were also nominally predicted by BMI PRS. LIMITATIONS The study utilized a cross-sectional design with a moderately sized sample. CONCLUSIONS Our findings suggest there may not be a shared genetic mechanism contributing to MDD and higher inflammatory marker levels. However, there may be shared genetic etiology between BMI and adulthood levels of CRP and IL-6. Therefore, polygenic risk scores for BMI may represent a useful indicator for heightened levels of inflammation in adulthood.
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Affiliation(s)
- Alish B Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Raymond Chung
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Souci Frissa
- Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura Goodwin
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; National Institute for Health Research Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience at the Maudsley Hospital and King's College London, UK
| | - Stephani L Hatch
- Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience at the Maudsley Hospital and King's College London, UK
| | - Timothy R Powell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Arias de la Torre J, Vilagut G, Ronaldson A, Dregan A, Ricci-Cabello I, Hatch SL, Serrano-Blanco A, Valderas JM, Hotopf M, Alonso J. Prevalence and age patterns of depression in the United Kingdom. A population-based study. J Affect Disord 2021; 279:164-172. [PMID: 33059219 DOI: 10.1016/j.jad.2020.09.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 08/03/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
METHODS A representative sample of the UK population (n=17,152) from the European Health Interview Survey of 2014 was included in the analyses. The Patient Health Questionnaire (PHQ-8) was used to assess the prevalence of depressive symptoms and of probable depressive disorder. Prevalence estimates (95%CI) were calculated. The association between prevalence and age was assessed using multivariable multinomial logistic and logistic regression models. All analyses were carried out for the total sample and stratified by sex. RESULTS The prevalence of depressive symptoms ranged from 11.3% (10.6-11.9) for mild, to 3.3% (3.0-3.7) for severe symptoms. The prevalence of probable depressive disorder was 7.5% (95%CI: 7.0-8.0). A significantly higher prevalence of probable depressive disorder was found in those aged 45 to 59 years old compared with those aged 16 to 29. For the prevalence of severe depressive symptoms those age differences were even higher: 2.55 times higher (5.38 for men and 1.75 for women). LIMITATIONS The cross-sectional design precludes stablishing the direction of the relationship between age and the prevalence. CONCLUSIONS The prevalence and age patterns of depression in the UK were described. A peak in the prevalence was identified during middle adulthood. These results could serve as a reference for the monitoring of depression in the UK and the development of preventive strategies, particularly in the high-risk population groups identified.
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Affiliation(s)
- Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King's College London, London, UK; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Gemma Vilagut
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King's College London, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King's College London, London, UK
| | - Ignacio Ricci-Cabello
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Illes Balears, Spain Health - Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Antoni Serrano-Blanco
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neurosciences (IoPPN), King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jordi Alonso
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Dept. of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
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Polling C, Woodhead C, Harwood H, Hotopf M, Hatch SL. "There Is So Much More for Us to Lose If We Were to Kill Ourselves": Understanding Paradoxically Low Rates of Self-Harm in a Socioeconomically Disadvantaged Community in London. Qual Health Res 2021; 31:122-136. [PMID: 32930046 PMCID: PMC7750675 DOI: 10.1177/1049732320957628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
London has unexpectedly low overall rates of self-harm in public health data and contains highly deprived areas with these paradoxically low rates. Qualitative data were collected via interviews and focus groups with 26 individuals living and working in one such area. Using the Stress Process Model, we explore why this ethnically diverse community, which is exposed to multiple, chronic stressors, might nonetheless appear to have low rates of self-harm. Participants described significant impacts of stressors on the mental health of people locally. These were partly buffered by social resources related to community solidarity and a culture of self-reliance. However, identifying oneself as mentally ill through being known to have self-harmed was seen as highly risky, diminishing a person's social status and exposing them to additional stressors from the community and services. Consequently, people tended to hide distress, respond with behaviors less linked to mental illness, and avoid mental health services.
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Affiliation(s)
- Catherine Polling
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
- South London and Maudsley NHS
Foundation Trust, London, United Kingdom
| | - Charlotte Woodhead
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
| | - Hannah Harwood
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
- South London and Maudsley NHS
Foundation Trust, London, United Kingdom
| | - Stephani L. Hatch
- Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, United
Kingdom
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Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in south east London. Eur Child Adolesc Psychiatry 2021; 30:1113-1128. [PMID: 32683491 PMCID: PMC8295086 DOI: 10.1007/s00787-020-01603-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
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Affiliation(s)
- Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Bhavsar V, Dorrington S, Morgan C, Hatch SL, McGuire P, Fusar-Poli P, Mills J, MacCabe JH, Hotopf M. Psychotic experiences, psychiatric comorbidity and mental health need in the general population: a cross-sectional and cohort study in Southeast London. Psychol Med 2021; 51:147-157. [PMID: 31713511 PMCID: PMC7116680 DOI: 10.1017/s0033291719003106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 08/15/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurrence of common mental disorders (CMD) with psychotic experiences is well-known. There is little research on the public mental health relevance of concurrent psychotic experiences for service use, suicidality, and poor physical health. We aim to: (1) describe the distribution of psychotic experiences co-occurring with a range of non-psychotic psychiatric disorders [CMD, depressive episode, anxiety disorder, probable post-traumatic stress disorder (PTSD), and personality dysfunction], and (2) examine associations of concurrent psychotic experiences with secondary mental healthcare use, psychological treatment use for CMD, lifetime suicide attempts, and poor self-rated health. METHODS We linked a prospective cross-sectional community health survey with a mental healthcare provider database. For each non-psychotic psychiatric disorder, patients with concurrent psychotic experiences were compared to those without psychotic experiences on use of secondary mental healthcare, psychological treatment for CMD, suicide attempt, physical functioning, and a composite multimorbidity score, using logistic regression and Cox regressions. RESULTS In all disorders except for anxiety disorder, concurrent psychotic experiences were accompanied by a greater odds of all outcomes (odds ratios) for a unit change in composite multimorbidity score ranged between 2.21 [95% confidence interval (CI) 1.49-3.27] and 3.46 (95% CI 1.52-7.85). Hazard ratios for secondary mental health service use for non-psychotic disorders with concurrent psychotic experiences, ranged from 0.53 (95% CI 0.15-1.86) for anxiety disorders with psychotic experiences to 4.99 (95% CI 1.22-20.44) among those with PTSD with psychotic experiences. CONCLUSIONS Co-occurring psychotic experiences indicate greater public mental health burden, suggesting psychotic experiences could be a marker for future preventive strategies improving public mental health.
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Affiliation(s)
- Vishal Bhavsar
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - John Mills
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - James H. MacCabe
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Rhead RD, Chui Z, Bakolis I, Gazard B, Harwood H, MacCrimmon S, Woodhead C, Hatch SL. Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: results from the TIDES study. BJPsych Open 2020; 7:e10. [PMID: 33323151 PMCID: PMC7791556 DOI: 10.1192/bjo.2020.137] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Harassment and discrimination in the National Health Service (NHS) has steadily increased over the past 5 years with London being the worst performing region. There is a lack of data and research on the impact this is having on staff health and job satisfaction. Such data are necessary to inform the development of effective workplace interventions to mitigate the effects these experiences have on staff. AIMS Examine the impact of harassment and discrimination on NHS staff working in London trusts, utilising data from the 2019 TIDES cross-sectional survey. METHOD In total, 931 London-based healthcare practitioners participated in the TIDES survey. Regression analysis was used to examine associations between the sociodemographic characteristics of participants, exposure to discrimination and harassment, and how such exposures are associated with physical and mental health, job satisfaction and sickness absence. RESULTS Women, Black ethnic minority staff, migrants, nurses and healthcare assistants were most at risk of discrimination and/or harassment. Experiencing either of the main exposures was associated with probable anxiety or depression. Experiencing harassment was also associated with moderate-to-severe somatic symptoms. Finally, both witnessing and experiencing the main exposures were associated with low job satisfaction and long periods of sickness absence. CONCLUSIONS NHS staff, particularly those working in London trusts, are exposed to unprecedented levels of discrimination and harassment from their colleagues. Within the context of an already stretched and under-resourced NHS, in order to combat poor job satisfaction and high turnover rates, the value of all healthcare practitioners must be visibly and continuously reinforced by all management and senior leaders.
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Affiliation(s)
- Rebecca D Rhead
- Department of Psychological Medicine, King's College London, UK
| | - Zoe Chui
- Department of Psychological Medicine, King's College London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department and Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Billy Gazard
- Department of Psychological Medicine, King's College London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, King's College London, UK
| | | | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
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Dregan A, Rayner L, Davis KAS, Bakolis I, Arias de la Torre J, Das-Munshi J, Hatch SL, Stewart R, Hotopf M. Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis. JAMA Psychiatry 2020; 77:598-606. [PMID: 31995135 PMCID: PMC6990710 DOI: 10.1001/jamapsychiatry.2019.4712] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023]
Abstract
Importance Previous research has linked a history of depression with arterial stiffness (AS) during midlife. Objective To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS). Design, Settings, and Participants This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019. Exposures Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference. Main Outcomes and Measures Peripherally assessed AS index (ASI) using digital photoplethysmography. Results Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association was for waist circumference, accounting for 25% of the association between depression and ASI levels (direct association: β = 0.26; 95% CI, 0.18-0.34; indirect association: β = 0.09; 95% CI, 0.06-0.11). Among men, hypertriglyceridemia accounted for 19% of the association between depression and ASI (direct association: β = 0.22; 95% CI, 0.05-0.40; indirect association: β = 0.05; 95% CI, 0.02-0.08). Conclusions and Relevance One-third of the association of depression with elevated ASI levels during midlife may be accounted for by combined MetS and inflammatory processes. Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.
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Affiliation(s)
- Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Lauren Rayner
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Katrina A. S. Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Ioannis Bakolis
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Jorge Arias de la Torre
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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40
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Bhavsar V, Hatch SL, Dean K, McManus S. Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the Adult Psychiatric Morbidity Survey. Eur Psychiatry 2020; 63:e51. [PMID: 32431256 PMCID: PMC7355179 DOI: 10.1192/j.eurpsy.2020.50] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Symptoms of mental disorder, particularly schizophrenia, predispose to victimization. Much less is known about the relationship between depressive symptoms and later victimization in the general population, the influence of these symptoms on types of subsequent victimization, or the role of symptom severity. We investigated this in nationally representative data from the United Kingdom. Methods: Data were from the Adult Psychiatric Morbidity Survey 2007. Multivariable logistic regressions estimated association between (a) prior depressive symptoms, (b) prior depressive symptoms with suicide attempt, and types of more recent victimization. Gender-specific associations were estimated using multiplicative interactions. Results: Prior depressive symptoms were associated with greater odds of any recent intimate partner violence (IPV), emotional IPV, sexual victimization, workplace victimization, any victimization, and cumulative victimization (adjusted odds ratio [aOR] for increasing types of recent victimization: 1.47, 95% confidence interval [CI]: 1.14, 1.89). Prior depressive symptoms with suicide attempt were associated with any recent IPV, emotional IPV, any victimization, and cumulative victimization (aOR for increasing types of recent victimization: 2.33, 95% CI: 1.22, 4.44). Self reported recalled data on previous depressive symptoms may have limited accuracy. Small numbers of outcomes for some comparisons results in imprecision of these estimates. Conclusions: Aside from severe mental illness such as schizophrenia, previous depressive symptoms in the general population are associated with greater subsequent victimization. Men and women with prior depressive symptoms may be vulnerable to a range of types of victimization, and may benefit from interventions to reduce this vulnerability.
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Affiliation(s)
- Vishal Bhavsar
- Department of Health Services and Population Research, Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Justice Health & Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Sally McManus
- National Center for Social Research, NatCen, London, United Kingdom
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Incecik E, Taylor RW, Valentini B, Hatch SL, Geddes JR, Cleare AJ, Marwood L. Online mood monitoring in treatment-resistant depression: qualitative study of patients' perspectives in the NHS. BJPsych Bull 2020; 44:47-52. [PMID: 31992374 PMCID: PMC7283130 DOI: 10.1192/bjb.2019.92] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS AND METHOD True Colours is an automated symptom monitoring programme used by National Health Service psychiatric services. This study explored whether patients with unipolar treatment-resistant depression (TRD) found this a useful addition to their treatment regimes. Semi-structured qualitative interviews were conducted with 21 patients with TRD, who had engaged in True Colours monitoring as part of the Lithium versus Quetiapine in Depression study. A thematic analysis was used to assess participant experiences of the system. RESULTS Six main themes emerged from the data, the most notable indicating that mood monitoring increased patients' insight into their disorder, but that subsequent behaviour change was absent. CLINICAL IMPLICATIONS Patients with TRD can benefit from mood monitoring via True Colours, making it a worthwhile addition to treatment. Further development of such systems and additional support may be required for patients with TRD to experience further benefits as reported by other patient groups.
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Affiliation(s)
- Emma Incecik
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rachael W Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,National Institute for Health Research Biomedical Research Centre at South London & Maudsley NHS Foundation Trust and King's College London, UK
| | - Beatrice Valentini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of General Psychology, University of Padova, Italy
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,National Institute for Health Research Biomedical Research Centre at South London & Maudsley NHS Foundation Trust and King's College London, UK
| | - John R Geddes
- Oxford Health NHS Foundation Trust, UK.,Department of Psychiatry, University of Oxford, UK
| | - Anthony J Cleare
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,National Institute for Health Research Biomedical Research Centre at South London & Maudsley NHS Foundation Trust and King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Lindsey Marwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
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42
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Powell TR, Duarte RRR, Hotopf M, Hatch SL, de Mulder Rougvie M, Breen GD, Lewis CM, Nixon DF. The behavioral, cellular and immune mediators of HIV-1 acquisition: New insights from population genetics. Sci Rep 2020; 10:3304. [PMID: 32094379 PMCID: PMC7039899 DOI: 10.1038/s41598-020-59256-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/30/2019] [Accepted: 01/13/2020] [Indexed: 11/09/2022] Open
Abstract
Millions are exposed to the human immunodeficiency virus type 1 (HIV-1) every year, but not all acquire the virus, suggesting a potential role for host genetics in the moderation of HIV-1 acquisition. Here, we analyzed summary statistics from the largest genome-wide association study of HIV-1 acquisition to-date, consisting of 6,334 infected patients and 7,247 population controls, to advance our understanding of the genetic mechanisms implicated in this trait. We found that HIV-1 acquisition is polygenic and heritable, with SNP heritability estimates explaining 28-42% of the variance in this trait at a population level. Genetic correlations alongside UK Biobank data revealed associations with smoking, prospective memory and socioeconomic traits. Gene-level enrichment analysis identified EF-hand calcium binding domain 14 as a novel susceptibility gene for HIV-1 acquisition. We also observed that susceptibility variants for HIV-1 acquisition were significantly enriched for genes expressed in T-cells, but also in striatal and hippocampal neurons. Finally, we tested how polygenic risk scores for HIV-1 acquisition influence blood levels of 35 inflammatory markers in 406 HIV-1-negative individuals. We found that higher genetic risk for HIV-1 acquisition was associated with lower levels of C-C motif chemokine ligand 17. Our findings corroborate a complex model for HIV-1 acquisition, whereby susceptibility is partly heritable and moderated by specific behavioral, cellular and immunological parameters.
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Affiliation(s)
- Timothy R Powell
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Rodrigo R R Duarte
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Gerome D Breen
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cathryn M Lewis
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Douglas F Nixon
- Division of Infectious Diseases, Weill Cornell Medicine, Cornell University, New York, NY, USA.
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43
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Boniface S, Lewer D, Hatch SL, Goodwin L. Associations between interrelated dimensions of socio-economic status, higher risk drinking and mental health in South East London: A cross-sectional study. PLoS One 2020; 15:e0229093. [PMID: 32059050 PMCID: PMC7021306 DOI: 10.1371/journal.pone.0229093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022] Open
Abstract
AIM To examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder. METHODS AND FINDINGS Between 2011-2013, 1,052 participants (age range 17-91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder. Harmful and dependent drinking was more common among people in Class 2 'economically inactive renters' (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07-8.71), Class 3 'economically inactive homeowners' (RRR 4.11, 95% CI 1.19-14.20) and Class 6 'professional renters' (RRR 3.51, 95% CI 1.14-10.78) than in Class 1 'professional homeowners'. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6. CONCLUSIONS Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms.
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Affiliation(s)
- Sadie Boniface
- Institute of Alcohol Studies, Alliance House, London, United Kingdom
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Dan Lewer
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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44
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Zavos HMS, Dalton B, Jayaweera K, Harber-Aschan L, Pannala G, Adikari A, Hatch SL, Siribaddana S, Sumathipala A, Hotopf M, Rijsdijk FV. The relationship between independent and dependent life events and depression symptoms in Sri Lanka: a twin and singleton study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:237-249. [PMID: 31482195 PMCID: PMC7024056 DOI: 10.1007/s00127-019-01765-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/30/2018] [Accepted: 08/20/2019] [Indexed: 12/05/2022]
Abstract
PURPOSE Life events have been associated with a variety of mental health conditions including depression. There is a scarcity of research in South Asia exploring the aetiology of independent and dependent life events and their relationship with depression symptoms. This study aimed, in a Sri Lankan population, to identify the socio-demographic correlates and genetic and environmental influences on independent and dependent life events and their relationship with depression. METHODS Questionnaire data came from the Colombo Twin and Singleton Follow-up Study, CoTaSS-2 (N = 3969), a population study of Sri Lankan twins and singletons. Lifetime-ever independent and dependent life events were measured using a questionnaire and depressive symptoms using the Revised Beck's Depression Inventory. Structural Equation Model-fitting analyses explored the genetic and environmental influences on life events and depression. RESULTS Living in a rural environment and financial hardship were associated with greater reporting of independent and dependent life events. Sex differences were evident in the aetiology of life events and depression symptoms. Independent and dependent life events, but not depression symptoms, were heritable in males. Independent life events and depression symptoms, but not dependent life events, were heritable in females. Non-shared environmental influences explained phenotypic associations between independent life events and depression symptoms in both males and females. Genetic and non-shared environmental influences explained the phenotypic associations between dependent life events and depression symptoms in males. Only non-shared environment explained the covariation between dependent life events and depression symptoms in females. CONCLUSIONS Socio-demographic correlates of independent and dependent life events were similar to those reported in Western populations. Life events were associated with increased depression symptoms. Contrary to research in Western populations, we found that non-shared environmental, rather than genetic, influences explained much of the covariation between life events and depression symptoms. This suggests that whilst independent LEs may be heritable, the relationship is unlikely to be confounded by genetic influences and has significant implications for possible interventions for depression.
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Affiliation(s)
- Helena M S Zavos
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Lisa Harber-Aschan
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Gayani Pannala
- Institute for Research and Development, Colombo, Sri Lanka
| | | | - Stephani L Hatch
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Sisira Siribaddana
- Department of Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Athula Sumathipala
- Institute for Research and Development, Colombo, Sri Lanka
- School of Primary, Community and Social Care, Faculty of Medicine & Health Sciences, Keele University, Staffordshire, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Frühling V Rijsdijk
- Social Genetic and Developmental Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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45
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Polling C, Bakolis I, Hotopf M, Hatch SL. Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study. BMJ Open 2019; 9:e032906. [PMID: 31628133 PMCID: PMC6803107 DOI: 10.1136/bmjopen-2019-032906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/06/2022] Open
Abstract
OBJECTIVES To compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data. SETTING A dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009-2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics. DESIGN Proportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested. RESULTS There were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for. CONCLUSIONS Hospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas where these data may underestimate rates relative to other areas.
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Affiliation(s)
- C Polling
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Stephani L Hatch
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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46
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Anderson FM, Hatch SL, Ryan EG, Trevillion K, Howard LM. Impact of Insecure Immigration Status and Ethnicity on Antenatal Mental Health Among Migrant Women. J Clin Psychiatry 2019; 80. [PMID: 31365196 DOI: 10.4088/jcp.18m12563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE There is limited evidence on the prevalence and odds of antenatal common mental disorders (CMDs) among migrant women and the effect on risk of intersecting variables such as immigration status and ethnicity. This study aimed to estimate the prevalence and odds of antenatal CMDs among migrant women compared to UK-born women in an inner-London maternity service. METHODS A cross-sectional survey stratified by response to depression screening questions was administered at first antenatal appointment. CMDs were assessed using the Structured Clinical Interview for DSM-IV. Recruitment took place between November 2014 and June 2016. RESULTS Prevalence of antenatal CMDs was 21% (95% CI, 16-28) among migrant women (n = 283) and 24% (95% CI, 18-31) among UK-born women (n = 262). There was no significant difference in the odds of CMDs among migrant women compared to UK-born women (OR = 0.86; P = .57; 95% CI, 0.51-1.44). Migrant women, particularly those with insecure immigration status, had increased odds of posttraumatic stress disorder (OR = 29.08; P < .01; 95% CI, 4-188). When analyses were stratified by ethnicity, there was no effect of migrant status for white women, but for ethnic minority (nonwhite) women, migrant status decreased odds of having a CMD (OR = 0.31; P = .02; 95% CI, 0.12-0.82). CONCLUSIONS Antenatal common mental disorders are prevalent among migrant women, but migrant status is unlikely to increase risk on its own. Immigration status, ethnicity, and other intersecting variables of social disadvantage must be investigated simultaneously to examine the perinatal mental health of heterogeneous migrant populations.
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Affiliation(s)
- Fraser M Anderson
- Section of Women's Mental Health, King's College, De Crespigny Park, London, SE5 8AF United Kingdom. .,Section of Women's Mental Health, King's College London, London, United Kingdom
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Elizabeth G Ryan
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Kylee Trevillion
- Section of Women's Mental Health, King's College London, London, United Kingdom
| | - Louise M Howard
- Section of Women's Mental Health, King's College London, London, United Kingdom
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Carter JL, Richards M, Hotopf M, Hatch SL. The roles of non-cognitive and cognitive skills in the life course development of adult health inequalities. Soc Sci Med 2019; 232:190-198. [PMID: 31100699 PMCID: PMC6783301 DOI: 10.1016/j.socscimed.2019.04.041] [Citation(s) in RCA: 5] [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] [Received: 06/07/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 12/23/2022]
Abstract
Previous research has suggested that greater cognitive skill is protective against the development of socioeconomic health inequalities across the life course, but the relative role of non-cognitive skills has been less investigated in this context. Using the prospective UK 1958 National Child Development Study (N = 18,558), higher factor scores for adolescent non-cognitive skills (NCS; i.e. a combination of work habits and pro-social behaviours) and mean cognitive skill (CS) at age 16 were examined with a path analysis model in relation to socioeconomic status (SES) across the life course (at ages 16, 33 and 50) and poor self-reported health at age 50. Adjusting for adolescent NCS explained over a third of the association between education and health, but the path between social class at age 50 and health was unaffected. Adjustment for CS explained larger proportions of the paths to adult health inequalities; and paths between CS and SES across the life course were stronger than the same paths with NCS. However, NCS was still independently associated with paths to later health inequalities in fully adjusted models, and both types of skill had equivalent inverse direct effects with poor health (OR: 0.82 [95% CI 0.73,0.93] vs 0.83 [0.72,0.96], respectively). Since NCS retained independent associations with SES and health across the life course, they could be a target for policies aimed at ameliorating the production of health inequalities for a wide range of children, regardless of their cognitive skill.
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Affiliation(s)
- Jennifer L Carter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, 33 Bedford Place, London, WC1B 5JU, UK.
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
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48
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Duncko R, Fischer S, Hatch SL, Frissa S, Goodwin L, Papadopoulos A, Cleare AJ, Hotopf M. Recurrence of Depression in Relation to History of Childhood Trauma and Hair Cortisol Concentration in a Community-Based Sample. Neuropsychobiology 2019; 78:48-57. [PMID: 30897568 DOI: 10.1159/000498920] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/17/2018] [Accepted: 02/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood trauma represents a risk factor for developing depression with increased rates of recurrence. Mechanisms involved include a disturbed regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Hair cortisol concentration (HCC) is a measure of long-term HPA axis activity with less interference from circadian and confounding factors. However, no study has so far used HCC to investigate the role of childhood trauma in recurrent pattern of depressive symptoms. METHODS A community-based sample of 500 participants was recruited, and depression was assessed at 3 time points using the Revised Clinical Interview Schedule. The Childhood Trauma Questionnaire was administered to identify a history of childhood trauma. Hair samples were obtained from 144 participants for analysis of cortisol. RESULTS Patients with recurrent depression had higher rates of childhood trauma compared to participants with no depression. Participants with current-only depression had increased HCC compared to the no depression group, while this was absent in participants with recurrent depression. Within the depressed group (both current-only and recurrent depression), those with a history of childhood physical abuse had lower HCC when compared to those with no such history. CONCLUSIONS Our findings show that retrospectively reported childhood trauma is associated with protracted trajectories of depression and a distinct pattern of long-term HPA axis activity.
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Affiliation(s)
- Roman Duncko
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, .,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom,
| | - Susanne Fischer
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Zurich, Switzerland.,Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Souci Frissa
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Papadopoulos
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anthony J Cleare
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom.,Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
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Abstract
This article explores how six Pakistani Muslim women interpret cultural concepts of izzat (honor and self-respect); what role, if any, it has in their lives; and whether there is interplay between upholding izzat and the participants' help-seeking strategies for mental health and well-being. Semistructured interviews were conducted and analyzed with an interpretative phenomenological analytic framework. Three themes were identified: (a) "the rules of izzat," (b) "negotiating tensions," and (c) "speaking out/breaking the 'rules.'" Findings highlighted new insights into the understanding of izzat and the implications these cultural concepts have for strategies in managing or silencing of psychological distress. Interviews illustrated tensions the participants experience when considering izzat, how these are negotiated to enable them to self-manage or seek help, and possible life experiences that might lead to self-harm and attempted suicide. Notably, cultural codes, in particular izzat, appear to vary over the life course and are influenced by migration.
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Affiliation(s)
| | | | - Jane Lawrence
- 2 University of East Anglia, Norwich, United Kingdom
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50
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Yamasaki S, Ando S, Richards M, Hatch SL, Koike S, Fujikawa S, Kanata S, Endo K, Morimoto Y, Arai M, Okado H, Usami S, Furukawa TA, Hiraiwa-Hasegawa M, Kasai K, Nishida A. Maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring: A population-based birth cohort study. Schizophr Res 2019; 206:52-57. [PMID: 30594455 DOI: 10.1016/j.schres.2018.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/01/2018] [Revised: 08/05/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022]
Abstract
Epidemiological studies have suggested that maternal diabetes in pregnancy increases the risk of schizophrenia in offspring. A recent cohort study observed that maternal diabetes in early pregnancy is also associated with psychotic experiences in the general adolescent population. However, it remains unclear whether maternal diabetes in early pregnancy is specifically associated with psychotic experiences, or is generally associated with broader mental health problems, including depressive symptoms in adolescence. The present study investigated the longitudinal associations between maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring. Our data were derived from the Tokyo Early Adolescence Survey, a population-based survey of early adolescents (N = 4478) and their primary caregivers. Diabetes in early pregnancy was determined by records in the mother's Maternal and Child Health Handbook, documented during the pregnancy. Psychotic experiences and depressive symptoms were established through self-report by the offspring at 10 years of age. Diabetes in early pregnancy was associated with an increased risk of hallucination in the offspring (auditory hallucination [odds ratio {OR} 4.33, 95% confidence interval {CI} 1.12-16.75]; visual hallucination [OR 6.58, 95% CI 1.69-25.66]), even after adjusting for depressive symptoms and other covariates. However, the association between maternal diabetes and delusional thoughts was not significant and diabetes in early pregnancy was not associated with adolescent depressive symptoms. Our investigation suggests that maternal diabetes in early pregnancy may specifically affect the risk of hallucinatory experiences in adolescent offspring.
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Affiliation(s)
- Syudo Yamasaki
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Shuntaro Ando
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 10 Cutcombe Road, London SE5 9RJ, UK
| | - Shinsuke Koike
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), The University of Tokyo, 3-8-1, Komaba, Meguro-ku, Tokyo 153-8902, Japan
| | - Shinya Fujikawa
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan
| | - Kaori Endo
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Yuko Morimoto
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Makoto Arai
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Haruo Okado
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Satoshi Usami
- Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (The Graduate University for Advanced Studies), Shonan Village, Hayama, Kanagawa 240-0193, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan. 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan.
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