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People have different emotional beliefs (or affective attitudes) towards organ donation (Morgan et al., 2008). The negative affective attitudes include the belief that the body should be kept whole (bodily integrity), feeling disgust towards organ donation (ick factor), concerns about unethical practices being undertaken by medical professionals (medical mistrust) and superstitious beliefs about organ donation (jinx). Perceived benefits is a positive affective attitude which focuses on the benefit of organ donation to the donor (e.g., donors are heroes). Previous research has found that negative affective attitudes deter people from registering as an organ donor, whilst perceived benefits promotes registration as a donor (O'Carroll et al., 2011; Shepherd & O'Carroll, 2014). Therefore, asking people to cognitively reappraise their perceptions of organ donation, to focus on its perceived benefits, may increase the likelihood of people registering as an organ donor. In this project, we will test whether asking people to focus on the perceived benefits of organ donation may increase the likelihood of people registering as an organ donor (i.e., opting-in) in an opt-out consent system. In this experiment, participants will be asked to either cognitively reappraise to focus on the perceived benefits of donation (cognitive reappraisal condition) or not (control condition). We will then see whether this improves organ donor registration 1 month later. We will also see the process through which this occurs.

People have different emotional beliefs (or affective attitudes) towards organ donation (Morgan et al., 2008). The negative affective attitudes include the belief that the body should be kept whole (bodily integrity), feeling disgust towards organ donation (ick factor), concerns about unethical practices being undertaken by medical professionals (medical mistrust) and superstitious beliefs about organ donation (jinx). Perceived benefits is a positive affective attitude which focuses on the benefit of organ donation to the donor (e.g., donors are heroes). Previous research has found that negative affective attitudes deter people from registering as an organ donor, whilst perceived benefits promotes registration as a donor (O'Carroll et al., 2011; Shepherd & O'Carroll, 2014). Therefore, asking people to cognitively reappraise their perceptions of organ donation, to focus on its perceived benefits, may increase the likelihood of people registering as an organ donor. In this project, we will test whether asking people to focus on the perceived benefits of organ donation may increase the likelihood of people registering as an organ donor (i.e., opting-in) in an opt-out consent system. In this experiment, participants will be asked to either cognitively reappraise to focus on the perceived benefits of donation (cognitive reappraisal condition) or not (control condition). We will then see whether this improves organ donor registration 1 month later. We will also see the process through which this occurs.

Background Waves 1 to 3 (March 2020 to May 2020) of the UK COVID-19 Mental Health and Wellbeing study suggested an improvement in some indicators of mental health across the first 6 weeks of the UK lockdown; however, suicidal ideation increased. Aims To report the prevalence of mental health and well-being of adults in the UK from March/April 2020 to February 2021. Method Quota sampling was employed at wave 1 (March/April 2020), and online surveys were conducted at seven time points. Primary analyses cover waves 4 (May/June 2020), 5 (July/August 2020), 6 (October 2020) and 7 (February 2021), including a period of increased restrictions in the UK. Mental health indicators were suicidal ideation, self-harm, suicide attempt, depression, anxiety, defeat, entrapment, loneliness and well-being. Results A total of 2691 (87.5% of wave 1) individuals participated in at least one survey between waves 4 and 7. Depressive symptoms and loneliness increased from October 2020 to February 2021. Defeat and entrapment increased from July/August 2020 to October 2020, and remained elevated in February 2021. Well-being decreased from July/August 2020 to October 2020. Anxiety symptoms and suicidal ideation did not change. Young adults, women, those who were socially disadvantaged and those with a pre-existing mental health condition reported worse mental health. Conclusions The mental health and well-being of the UK population deteriorated from July/August 2020 to October 2020 and February 2021, which coincided with the second wave of COVID-19. Suicidal thoughts did not decrease significantly, suggesting a need for continued vigilance as we recover from the pandemic.

Background: \ud The lasting effects of the coronavirus disease 2019 pandemic are likely to be significant.\ud \ud Aims: \ud This study tracked worry and rumination levels during the pandemic and investigated whether periods with higher COVID-related worry and rumination were associated with more negative mental health and loneliness.\ud \ud Methods: \ud A quota survey design and a sampling frame that permitted recruitment of a national sample were employed. Findings for waves 1 (March 2020) to 6 (November 2020) are reported (N = 1943).\ud \ud Results: \ud Covid-related worry and rumination levels were highest at the beginning of the first lockdown, then declined but increased when the UK returned to lockdown. Worry levels were higher than rumination levels throughout. High levels of COVID-related worry and rumination were associated with a five- and ten-fold increase in clinically meaningful rates of depression and anxiety (respectively) together with lower well-being and higher loneliness. The effects of COVID-related worry on depression and anxiety levels were most marked and clinically meaningful in individuals living with a pre-existing mental health condition.\ud \ud Conclusions: \ud Psychological interventions should include components that specifically target COVID-related worry and rumination. Individuals with pre-existing mental health conditions should be prioritised as we emerge from the current pandemic and in any future public health crises.

ObjectivesColorectal cancer (CRC) screening uptake in Scotland is 56%. This study examined whether psychological factors were associated with CRC screening uptake.DesignCross-sectional observational study.SettingThis study used data from the Healthy AGeing In Scotland (HAGIS) pilot study, a study designed to be representative of Scottish adults aged 50 years and older.Participants908 (505 female) Scottish adults aged 50–80 years (mean age=65.85, SD=8.23), who took part in the HAGIS study (2016–2017).Primary and secondary outcome measuresSelf-reported participation in CRC screening was the outcome measure. Logistic regression was used to test whether scores on measures of health literacy, cognitive ability, risk aversion, time preference (eg, present oriented or future oriented) and personality were associated with CRC screening when these psychological factors were entered individually and simultaneously in the same model.ResultsControlling for age, age-squared, sex, living arrangement, and sex*living arrangement, a one-point increase in risk aversion (OR=0.66, 95% CI 0.51 to 0.85) and present orientation (OR=0.86, 95% CI 0.80 to 0.94) was associated with reduced odds of screening. Higher scores on health literacy (OR per one-point increase=1.20, 95% CI 1.09 to 1.31), cognitive ability (OR per SD increase=1.51, 95% CI 1.25 to 1.81) and the intellect personality trait (OR per one-point increase=1.05, 95% CI 1.01 to 1.09) were associated with increased odds of screening. Higher risk aversion was the only psychological variable that was associated with CRC screening participation when all psychological variables were entered in the same model and remained associated with CRC screening when additionally adjusting for deprivation and education. A backward elimination model retained two psychological variables as correlates of CRC screening: risk aversion and cognitive ability.ConclusionIndividuals who are more risk averse are less likely to participate in free, home CRC screening.

ObjectiveColorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers.DesignThis is a cross-sectional study.SettingParticipants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire.ParticipantsThe study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female).Outcome measuresThe questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions.ResultsParticipants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=−3.21, pConclusionThis survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.

(1) Background: Antibiotic (AB) usage in food animals is a significant contributor to antimicrobial resistance (AMR). Vaccination can reduce the over-use of AB treatment. Little is known about farmers’ attitudes and beliefs about AB and vaccine usage in developing countries, especially in aquaculture. (2) Methods: We used the necessity/concerns framework to guide our research, where vaccine hesitancy is viewed as a function of the perceived necessity versus the perceived concerns about treatment. We measured disease and treatment perceptions in 400 Vietnamese farmers of Pangasius catfish, specifically regarding (a) chemical treatment of water, (b) antibiotic usage, and (c) vaccination of fish. (3) Results: Although farmers’ concerns about AB usage outweighed necessity beliefs, 86.5% reported having used ABs on their farm. Knowledge and attitudes towards vaccination were positive, with views of its necessity outweighing concerns. However, if available, only 67.6% said they would definitely use vaccines in the future. Farmers were more likely to use vaccines if they reported having fewer problems with fish disease, felt that any concerns about vaccines were outweighed by their perceived benefits, had less mistrust of vaccination, and had fewer concerns about commercial profiteering. (4) Conclusion: Interventions that highlight concerns about continued antibiotic use, reduce concerns, and mistrust and increase the perceived necessity of vaccines combined with greater availability of vaccines may be the most effective way of overcoming vaccine hesitancy and increase appropriate use of vaccines by Vietnamese fish farmers.

Objective Smoking during pregnancy causes risks to mother and infant health. We investigated the feasibility and likely success of SKIP-IT, a narrative and picture-based smoking cessation intervention delivered via text messages. Methods A feasibility and pilot trial. We aimed to recruit 70 pregnant women who smoked, randomised to usual care alone or usual care and the SKIP-IT intervention between 12 weeks of pregnancy and 6 weeks post due-date. Outcomes assessed were recruitment, retention, acceptability of, and engagement with the intervention, smoking behaviour, intentions, perceived risk, and self-efficacy. Results Of 312 women initially approached by smoking cessation services only 54 (17%) agreed to be contacted by the research team. Twenty were then either ineligible or uncontactable and 28 (82%) participated. Most women reported texts to be entertaining and helpful. The proportion of women not smoking at follow-up was lower in the intervention group, but numbers were too small to draw conclusions about effectiveness. Conclusion The intervention was acceptable, but difficulty in making initial and follow-up contacts meant our methods were unfeasible for a larger trial. Practice implications Digital Storytelling interventions could help women quit smoking, but further research is required to identify alternative methods for studies with pregnant women who smoke.

Background; The effects of COVID-19 on the population's mental health and wellbeing are likely to be profound and long-lasting.\ud Aims: To investigate the trajectory of mental health and wellbeing during the first six weeks of lockdown in adults in the UK.\ud Method: A quota survey design and a sampling frame that permitted recruitment of a national sample was employed. Findings for waves 1 (31st March to 9th April 2020), 2 (10th April to 27th April 2020) and 3 (28th April to 11th May 2020) are reported here. A range of mental health factors was assessed: pre-existing mental health problems, suicide attempts and self-harm, suicidal ideation, depression, anxiety, defeat, entrapment, mental well-being, and loneliness.\ud Results: A total of 3077 adults in the UK completed the survey at wave 1. Suicidal ideation increased over time. Symptoms of anxiety, levels of defeat and entrapment decreased across waves whereas levels of depressive symptoms did not change significantly. Positive wellbeing also increased. Levels of loneliness did not change significantly over waves. Sub- group analyses showed that females, young people (18-29 years), those from more socially disadvantaged backgrounds, and those with pre-existing mental health problems have worse mental health outcomes during the pandemic across most factors.\ud Conclusions: The mental health and wellbeing of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.

Background: Alcohol interventions are important to the developing public health role of community pharmacies.\ud The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists\ud (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of\ud alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to\ud investigate all study procedures to inform progression to a definitive trial.\ud Methods: This cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each\ud who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation\ud was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in\ud MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked\ud by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected\ud for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but\ud patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per\ud unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management.\ud Trial procedures were assessed by recruitment, attrition, and follow-up rates.\ud \ud Results: 260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for\ud eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented\ud to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the\ud intervention arm and confidence in medication management reduced slightly for both groups. Exploration of\ud recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure\ud and 7-day guided recall of alcohol consumption.\ud Conclusions: The pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy\ud and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not\ud possible to conduct a definitive trial of the intervention in this service.\ud Trial registration: ISRCTN57447996\ud Keywords: Alcohol, Community pharmacy, Medicine reviews, Pilot trial, Feasibility

Objectives. To overcome the shortage of organ donors, Scotland and England are introducing an opt-out organ donor registration system in 2020. This means individuals will be automatically considered to consent for donation unless they actively opt-out of the register. Research has found that emotional barriers play a key role in donor decisions under opt-in legislation, yet little is known about factors that influence donor decisions under opt-out consent. Our objectives were to investigate attitudes towards organ donation and opt-out consent from individuals who plan to opt-out, and to explore the reasons why they plan to opt-out. Design. Qualitative interview study Methods. Semi-structured interviews were conducted with 15 individuals from Scotland (n=14) and England (n=1) who self-reported the intention to opt-out of the register following the legislative change to opt-out. The interviews were transcribed verbatim and analysed using thematic analysis. Results. Three main themes were identified; (1) consent versus coercion, which describes the perception of freedom of choice under an opt-in system and fears of “Government interference” and threatened autonomy under opt-out, (2) self-protection, encompassing fears of medical mistrust, bodily integrity concerns and apprehension regarding the recipient selection process. Lastly, (3) ‘riddled with pitfalls’, which includes the notion that opt-out consent may increase susceptibility of stigma and reproach when registering an opt-out decision. Conclusions. This study reinforces existing opt-in literature surrounding medical mistrust and bodily integrity concerns. A threat to one’s autonomous choice and heightened reactance arising from perceptions of unwarranted Government control have emerged as novel barriers.

Additional file 6. Questionnaire Booklet; contains some further questions on participants’ thoughts on having a colonoscopy and on the information provided to them.

Additional file 4. Bowel Screening Test Booklet; the current leaflet provided to Scottish Bowel Screening Participants at the time of screening invitation to explain the benefits of participating in screening.

Additional file 1. Scenario letters booklet for numerical risk study arm; shows three imaginary bowel screening result letters with a numerical risk of having colorectal cancer, along with some short questions to complete.

Additional file 7. Internal reliability of study measures; contains the results of statistical tests to measure the internal reliability of several of the study measures.

Additional file 2. Scenario letters booklet for categorical risk study arm; shows three imaginary bowel screening result letters with a categorical risk of having colorectal cancer, along with some short questions to complete.

Additional file 3. Scenario letters booklet for control group (positive result letter) study arm; shows the current letter sent to Scottish Bowel Screening participants following a positive screening result.

Background Alcohol interventions are important to the developing public health role of community pharmacies. The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to investigate all study procedures to inform progression to a definitive trial. Methods This cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management. Trial procedures were assessed by recruitment, attrition, and follow-up rates. Results 260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the intervention arm and confidence in medication management reduced slightly for both groups. Exploration of recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure and 7-day guided recall of alcohol consumption. Conclusions The pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not possible to conduct a definitive trial of the intervention in this service.

Prosociality can either be costly (e.g., donating to charity) or costless (e.g. posthumous organ donation). Whereas links between personality and costly prosociality and have been explored, links with costless prosociality and personality are at present unknown. We address this in two studies. Study 1 (N = 200) confirms the distinction between costless and costly prosociality based on willingness to engage with health and non-health prosociality. Study 2, using data from 4 samples (student and community; N = 733) shows that across incentivized and hypothetical economic games to assess costless (generosity game; GG) and costly (dictator game; DG) prosociality, that organ donor behavior was linked to greater allocations in the GG and charity/volunteering behavior in the DG. Costless and costly prosocialities are associated with different personality traits (e.g., costly with politeness and compassion, and costless with intellect). Implications for cooperative phenotypes and recruiting organ donors are discussed.

First paragraph: MacDonald et al1 report an important study showing that health‐related quality of life (HRQL) predicted mortality in 405 patients with cirrhosis and severe ascites. HRQL was assessed using the SF‐36 which has two main subscales assessing physical (PCS) and mental (MCS) components. They found (a) patients with severe ascites reported poor HRQL (particularly PCS), (b) PCS was not correlated with traditional markers of liver disease and (c) after controlling for confounders, PCS (but not MCS) was a significant predictor of all‐cause and cirrhosis‐related death. While the presence of diuretic‐refractory ascites is known to be a predictor of mortality, HRQL is not a component of the current model for end‐stage liver disease (MELD).

Introduction: In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments.Methods and analysis: The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention.Ethics and dissemination: The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations.Trial registration number ISRCTN11057518; Pre-results.

Introduction In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments. Methods and analysis The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention. Ethics and dissemination The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations.

Introduction: In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments.\ud \ud Methods and analysis: The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention.\ud \ud Ethics and dissemination: The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations.\ud \ud Trial registration number: ISRCTN11057518; Pre-results.

Background: There are few prevalence studies of suicide attempts (SAs) and non-suicidal self-harm (NSSH). Aims: This study aimed to estimate the prevalence of thoughts of NSSH, suicidal thoughts, NSSH and SAs among 18-34 year olds in Scotland for the first time.Method: We interviewed a representative sample of young adults from across Scotland. Results: 3508 young people were interviewed. 11·3% and 16·2% reported a lifetime history of SAs and NSSH, respectively. The first episode of NSSH tended to precede the first SA by about two years. Age of onset of NSSH and SA was younger in females. Earlier age of onset was associated with more frequent NSSH/SA. Women are significantly more likely to report NSSH and SA compared to men. Conclusion: One in 9 young people has attempted suicide and 1 in 6 has engaged in NSSH. Clinicians should be vigilant as SAs and NSSH are relatively common.

Supplemental Material, SPPS765071_suppl_mat for Costless and Costly Prosociality: Correspondence Among Personality Traits, Economic Preferences, and Real-World Prosociality by Eamonn Ferguson, Kun Zhao, Ronan E. O'Carroll, and Luke D. Smillie in Social Psychological and Personality Science

Objective: There are approximately 6,500 people on the UK national transplant waiting list, around 400 of whom die every year. Only 35% of the UK population are currently on the organ donation register. We report 2 studies examining whether a reciprocity prime, in which participants were asked whether they would accept a donated organ, increased organ donation intentions and behaviour. Design: Between participants, randomized-controlled design. Methods: In 2 studies, participants who were not currently registered organ donors took part either face-to-face or online, and were randomly allocated to a reciprocity prime or control condition. Following the manipulation they were asked to indicate, on either a paper or online questionnaire, their intention to join the organ donor register. Study 2 was similar to Study 1 but with the addition that after reporting intention, participants were then offered an organ donation information leaflet or the opportunity to click a link for further information (proxy behavioural measure). Results: In both studies, reciprocity primed participants reported greater intentions to register than controls. However, in Study 2, no effect on donation behaviour was found. Conclusions: Reciprocal altruism may be a useful tool in increasing intentions to join the organ donor register. Further evaluation is required to determine whether this increase in intention can be translated into organ donation behaviour.

ObjectivesRaising cancer awareness and addressing barriers to help-seeking may improve early diagnosis. The aim was to assess whether a psycho-educational intervention increased adolescents' cancer awareness and addressed help-seeking barriers.MethodsThis was a cluster randomised controlled trial involving 2173 adolescents in 20 schools. The intervention was a 50-min presentation delivered by a member of Teenage Cancer Trust's (UK charity) education team. Schools were stratified by deprivation and roll size and randomly allocated to intervention/control conditions within these strata. Outcome measures were the number of cancer warning signs and cancer risk factors recognised, help-seeking barriers endorsed and cancer communication. Communication self-efficacy and intervention fidelity were also assessed.ResultsRegression models showed significant differences in the number of cancer warning signs and risk factors recognised between intervention and control groups. In intervention schools, the greatest increases in recognition of cancer warning signs at 6-month follow-up were for unexplained weight loss (from 44.2% to 62.0%) and change in the appearance of a mole (from 46.3% to 70.7%), up by 17.8% and 24.4%, respectively. Greatest increases in recognition of cancer risk factors were for getting sunburnt more than once as a child (from 41.0% to 57.6%) and being overweight (from 42.7% to 55.5%), up by 16.6% and 12.8%, respectively. Regression models showed that adolescents in intervention schools were 2.7 times more likely to discuss cancer at 2-week follow-up compared with the control group. No differences in endorsement of barriers to help-seeking were observed.ConclusionsSchool-based brief psycho-educational interventions are easy to deliver, require little resource and improve cancer awareness.

Those who self-harm have been shown to be less sensitive to physical pain, but more sensitive to emotional pain, appearing to contradict social neuroscience research that suggests that individuals who are more sensitive to physical pain are also more sensitive to emotional pain. The current study investigated the relationship between self-reported emotional pain sensitivity and physical pain distress in those who think (ideate) about and engage in (enact) self-harm. A total of 351 healthy adults completed a battery of anonymous online questionnaires assessing emotional sensitivity, physical pain distress and sensitivity, and lifetime history of self-harm, as well as depressive symptoms, self-critical style, perfectionistic cognitions, and perfectionistic self-presentation. Emotional sensitivity and physical pain distress were higher in both the self-harm ideation and enactment groups than in controls and there was a significant ordered effect, such that the enactment group was more sensitive to emotional and physical pain than the ideation group. A similar significant ordered effect in physical pain sensitivity was observed only when controlling for previous suicide attempt. Within the ideation group, physical pain distress and self-critical style were the only factors significantly associated with emotional pain sensitivity, but only the presence of perfectionistic cognitions was significantly associated with emotional pain sensitivity in the enactment group. Taken together, the findings suggest an association between self-perceived emotional sensitivity and physical pain distress in self-harm ideation, but possibly a disconnection between self-perceived and behavioral sensitivity to physical pain in self-harm enactment. Furthermore, self-criticism and perfectionism may be differentially associated with emotional sensitivity in self-harm ideation and enactment.Read More: http://guilfordjournals.com/doi/abs/10.1521/ijct.2015.8.2.156

Generic (i.e. non-branded medicine) and therapeutic (i.e. a less expensive drug from the same class) substitution of medication provides considerable financial savings, but may negatively impact on patients. We report secondary qualitative/quantitative analysis of stroke survivors from a pilot randomised controlled brief intervention to increase adherence to medication. Patients' experiences of medication changes were examined in conjunction with electronically-recorded medication adherence. Twenty-eight patients reported frequent medication changes (e.g. size/shape/colour/packaging) and two-thirds of these reported negative effects, resulting in, at least, confusion and, at worst, mistakes in medication-taking. Patients reporting a direct effect on their medication-taking (n = 6) demonstrated poorer objectively-measured adherence (i.e. % doses taken on schedule) than those reporting confusion [mean difference = 19.9, 95 % CI (2.0, 37.8)] or no problems [mean difference = 20.6, 95 % CI (1.6, 40.0)]. Changes to medication resulting from switching between generic brands can be associated with notable problems, including poorer medication adherence, for a significant minority.

OBJECTIVE: The purpose of the current study was to test theory-based predictions of mediators and moderators of treatment effects of a pilot randomized controlled trial, which aimed to increase adherence to preventive medication in stroke survivors via addressing both automatic (i.e., habitual responses) and reflective (i.e., beliefs and value systems) aspects of medication-taking behavior. METHOD: Sixty-two stroke survivors were randomly allocated to either an intervention or control group. Intervention participants received a brief 2-session intervention aimed at increasing adherence via (a) helping patients establish better medication-taking routines using implementation intentions plans (automatic), and (b) eliciting and modifying any mistaken patient beliefs regarding medication and/or stroke (reflective). The control group received similar levels of non-medication-related contact. Primary outcome was adherence to antihypertensive medicine measured objectively over 3 months using an electronic pill bottle. Secondary outcome measures included self-reported adherence (including forgetting) and beliefs about medication. RESULTS Intervention participants had 10% greater adherence on doses taken on schedule (intervention, 97%; control, 87%; 95% CI [0.2, 16.2], p = .048), as well as significantly greater increases in self-reported adherence and reductions in concerns about medication. Treatment effects were mediated by reductions in both forgetting and concerns about medication, and moderated by the presence of preexisting medication-taking routines. CONCLUSIONS: Addressing both automatic and reflective aspects of behavior via helping stroke survivors develop planned regular routines for medication-taking, and addressing any concerns or misconceptions about their medication, can improve adherence and thus potentially patient outcomes.

Background: Approximately a quarter to a half of all people fail to take their medication regimen as prescribed (i.e. non-adherence). Conscientiousness, from the five-factor model of personality, has been positively linked to adherence to medications in several recent studies. Purpose: This study aimed to systematically estimate the strength and variability of this association across multiple published articles and to identify moderators of this relationship. Method: A literature search identified 16 studies (N = 3,476) that met the study eligibility criteria. Estimates of effect sizes (r) obtained in these studies were meta-analysed. Results: Overall, a higher level of conscientiousness was associated with better medication adherence (r = 0.15; 95 % CI, 0.09, 0.21). Associations were significantly stronger in younger samples (r = 0.26, 95 % CI, 0.17, 0.34; k = 7). Conclusion: The small association between conscientiousness and medication adherence may have clinical significance in contexts where small differences in adherence result in clinically important effects

Background: The authors previously reported the early results of a trial of a brief psychological intervention to increase physical activity in patients with intermittent claudication. After 4 months, participants in the intervention group walked a mean of 1576 more steps per day than control group participants. The present study followed the original participants to determine whether this behaviour change was maintained over 2 years. Methods: This was a randomized single-centre parallel-group trial. Fifty-eight patients newly diagnosed with intermittent claudication were assigned randomly to one of two groups. The control group (30 patients) received usual care: lifestyle advice and consultation with a vascular surgeon to agree a treatment plan. The treatment group (28) received usual care plus a brief psychological intervention designed to modify illness and walking beliefs, and develop a personalized walking action plan. The primary outcome was daily steps measured by pedometer. Secondary outcomes included revascularization rate, quality of life and perceived pain-free walking distance. Follow-up was conducted at 1 and 2 years. Between-group differences were analysed by analysis of co-variance. Results: Participants in the brief psychological intervention group walked significantly more than those in the control group. The mean difference at 1 year was 1374 (95 per cent confidence interval 528 to 2220) steps per day and the difference at 2 years was 1630 (495 to 2765) steps per day. Conclusion: Modifying illness and walking beliefs, and assisting patients to develop a personalized walking action plan led to increases in walking behaviour in patients with claudication that were maintained for 2 years. Registration number: ISRCTN28051878 (http://www.controlled-trials.com).

Background: Although suicide is a global public health concern with approximately one million people dying by suicide annually, our knowledge of the proximal risk mechanisms is limited. In the present study, we investigated the utility of two proximal mechanisms (goal disengagement and goal reengagement) in the prediction of hospital-treated self-harm repetition in a sample of suicide attempters.Methods: Two hundred and thirty-seven patients hospitalised following a suicide attempt completed a range of clinical (depression, anxiety, hopelessness, suicidal ideation) and goal regulation measures (goal reengagement and disengagement) while in hospital. They were followed up two years later to determine whether they had been re-hospitalised with self-harm between baseline and the follow-up.Results: Self-harm hospitalisation in the past 10 years, suicidal ideation and difficulty reengaging in new goals independently predicted self-harm two years later. In addition, among younger people, having difficulty re-engaging in new goals further predicted self-harm re-hospitalisation when disengagement from existing unattainable goals was also low. Conversely, the deleterious impact of low reengagement in older people was elevated when goal disengagement was also high.Limitations: Only hospital-treated self-harm and suicide were recorded at follow-up, episodes of less medically serious self-harm were not recorded.Conclusions: Suicidal behaviour is usefully conceptualised in terms of goal self-regulation following the experience of unattainable goals. Treatment interventions should target the self-regulation of goals among suicide attempters and clinicians should recognise that different regulation processes need to be addressed at different points across the lifespan.

Objective: Type D personality has been proposed as a risk factor for poor prognosis in cardiac patients. Recent studies which have adopted a dimensional approach to Type D (negative affectivity×social inhibition) found no effect of Type D on mortality, after controlling for its constituent elements. To-date, no study has determined if Type D is associated with psychosocial outcomes in post-myocardial infarction (MI) patients when conceptualised as a dimensional variable. Methods: Participants were 192 MI patients (138 males, 54 females, mean age 66.0 years) who provided demographic and clinical information, and completed measures of Type D one-week post-MI. Three months later, 131 of these MI patients completed measures of disability and quality of life. Results: Using regression analyses, adjusted for demographic and clinical data, Type D emerged as a significant predictor of disability and quality of life in MI patients, when analysed using the traditional categorical approach. However, Type D did not predict disability and quality of life when it was analysed using the interaction of negative affectivity and social inhibition. Negative affect emerged as a significant predictor of both disability (β=.433, t(130)=3.53, p less than .01), and quality of life (β=−.624, t(130)=−5.68, p less than .001). Conclusions: The results suggest that Type D is not associated with short-term psychosocial outcome in MI patients, after controlling for its constituent elements. However, negative affect was significantly associated with both disability and quality of life. Future research should conceptualise Type D as the interaction between negative affectivity and social inhibition, rather than as a typology.

BACKGROUND Increased walking is often recommended for patients with intermittent claudication (IC). Current methods to increase walking in these patients increase capability but not daily behaviour. This trial assessed whether a brief psychological intervention could increase daily walking at 4 months. METHODS This randomized, single-centre, parallel-group trial was conducted between April 2008 and July 2010. Patients newly diagnosed with IC were randomly assigned into two groups. All clinical staff involved in patient management were blinded to allocation. The control group received usual care plus researcher contact, and the treatment group received usual care and a brief psychological intervention to modify illness and walking beliefs and to develop a personalized walking action plan. The psychological intervention was delivered in two 1-h sessions in participants' homes. The primary outcome was daily steps measured by pedometer 4 months later. Analyses were by intention to treat. RESULTS Of 109 patients screened, 72 were eligible for inclusion; 58 patients consented to participate and were randomly allocated to usual care (30) or brief psychological intervention (28). All 58 participants were included in the analysis of the primary outcome. Compared with controls at 4-month follow-up, participants who received the psychological intervention walked a mean of 1575·63 (95 per cent confidence interval 731·97 to 2419·29) more steps per day. There were no adverse events. CONCLUSION A brief psychological intervention significantly increased daily walking in patients with IC at 4 months. This study provided support for a potentially new direction in the treatment of IC. Registration number: ISRCTN28051878 (http://www.controlled-trials.com).

Objective: To identify the relative risk (RR) of mortality in bereaved parents compared with non-bereaved counterparts. Design: Retrospective data linkage study. Setting: United Kingdom, 1971-2006. Participants: A random sample from death registrations (5%) of parents who had a live birth where the infant lived beyond its first year of life (non-bereaved parents) and parents who had experienced a stillbirth or the death of a child in its first year of life (bereaved parents) between 1971 and 2006. Main outcome measures: Death or widowhood of the parent. Results: Bereaved parents in Scotland (n=738) were more than twice as likely to die in the first 15 years after their child's death than non-bereaved parents (n=50 132), p

Type D personality, the combination of negative affectivity and social inhibition, is an emerging risk factor in cardiovascular disease. The current study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females, 138 males) completed measures of Type D personality and provided demographic and medical information one week post-MI, and 131 then went on to complete a self-report measure of medication adherence three months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, negative affectivity and social inhibition, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions which target the self-management of medication may be useful in these high-risk patients.

The main objective of this study was to identify how bereaved mothers describe their coping strategies in their own words. The literature on parental bereavement is sparse, and the present study aims to add to existing knowledge by eliciting the mothers' experiences covering a wide range of child ages including infants, younger children and adults. Semi-structured interviews were held with 13 bereaved mothers in the UK. Causes of death include accident, illness and suicide. The methodological approach was interpretative phenomenological analysis (IPA). This article reports two inter-related recurrent themes: (1) Continuing the bond with the deceased child and (2) Ambivalence to personal mortality. Participants reported that the relationship with their child was continued in a variety of ways, from tending to the grave and the child's remains, through linking objects or by establishing a symbolic representation of the child within their daily lives. All mothers talked openly about their own mortality, either demonstrating ambivalence about their own death, or expressing clear suicidal ideation. Death was seen as a release from living with the pain of loss. The presence of surviving siblings appeared to moderate suicidal ideation, but mothers expressed concerns about their ability to care adequately for other family members during times of intense grief.

Forty-six patients with mild cognitive impairment (MCI), twenty patients with very early Alzheimer’s disease (AD), twenty psychiatric outpatients with depressive symptoms, and 24 health elderly volunteers were examined cross-sectionally using clinical and neuropsychological scales. Patients with amnestic mild cognitive impairment were followed up on average for four years. Smaller subgroups of patients were examined with an α4β2-nicotinic ligand tracer and single photon emission tomography, and diffusion tensor magnetic resonance imaging to examine white matter tract micro-integrity. One quarter of referrals to our Edinburgh neuropsychological assessment service for older people received the diagnosis of amnestic mild cognitive impairment (aMCI). Most of these also displayed non-memory cognitive deficits, without qualifying for a diagnosis of dementia. While some of the neuropsychological measures were highly specific and sensitive to early dementia, they achieved usually only one of the two for aMCI. Two fifths or our aMCI patients ‘converted’ to AD within four years of follow-up. They could be predicted at baseline with an accuracy of 75%. Typical patterns of nicotinic receptor binding and white matter integrity were found in patients with MCI.

Magnetic seizure therapy, in which seizures are elicited with a high-frequency magnetic field, is under development as a new treatment for major depressive disorder. Its use may be justified if it produces the antidepressant effects of electroconvulsive therapy (ECT), coupled with limited cognitive side-effects.To evaluate the usefulness of a new 100 Hz magnetic seizure therapy device.We induced seizures with 100 Hz magnetic transcranial stimulation in 11 patients with major depressive disorder during one session of a regular course of ECT. Recovery times after seizures induced by magnetic seizure therapy and ECT were compared.Seizures could be elicited in 10 of the 11 patients. Stimulation over the vertex produced tonic-clonic activity on 9 out of 11 occasions. Stimulation over the prefrontal midpoint elicited seizures on 3 out of 7 occasions. The mean duration of magnetically induced seizures was 31.3 s, ranging from 10 to 86 s. All patients had an exceptionally quick recovery of orientation: mean of 7 min 12 s (s.d.=2 min 7 s, range 4 min 20 s to 9 min 41 s). The recovery times were on average 15 min 35 s shorter with magnetic seizure therapy than with ECT in the same patients (paired-samples t-test: P0.0001). Patients reported feeling less confused after magnetic seizure therapy. Side-effects were confined to myoclonic movements, associated with the use of etomidate.The new 100 Hz magnetic stimulator elicits seizures in the majority of patients when administered over the vertex. Magnetic seizure therapy was associated with shorter recovery times and less confusion following treatment. Subsequent work will be required to assess the safety and effectiveness of magnetic seizure therapy in the treatment of depression.

Eight acutely ill deluded schizophrenic patients were compared with eight matched recovered patients on an associative learning task. Ten word pair associations were presented over five trials. Subsequently the subjects were presented with ten novel pairings over three trials, one word from the first pair associated with a new partner. Recovered patients performed better than acutely ill patients on both stages of the task. This result does not support the neuropsychological model of Gray et al. (1991) which predicts that acute schizophrenia is characterised by a weakening of the effect of previous experience on new learning.

A series of studies are presented which attempt to answer specific questions concerning the androgen-behaviour relationship in the adult human male. A critical review of the literature revealed that the androgen-behaviour relationship in the human male has been poorly researched. In particular, unsatisfactory experimental methodology and inexact operational definitions of behaviour have been employed. In the studies presented in this thesis an attempt was made to specifically define dysfunctional states and to carefully monitor the resultant behavioural effects of androgen administration. In the hypogonadal man, a dose-dependent relationship was demonstrated for specific aspects of sexual functioning, in particular self-rated interest in sex and frequency of morning erections appeared to vary with androgen replacement dose. In the eugonadal man, intramuscular depot injections of testosterone were shown to be the best method of overcoming the homeostatic mechanisms and increasing circulating androgen levels in the blood. High dosage testosterone administration acted to increase the level of sexual interest of a group of men whose presenting complaint was loss of libido. This treatment, however, did not result in an increased frequency of sexual activity. High dosage testosterone administration had no behavioural effect, compared with placebo, in a group of eugonadal men presenting with erectile dysfunction. Androgen administration appeared to have a stimulatory effect on the nocturnal erections of a group of hypogonadal men, although androgen withdrawal resulted in differing rates of diminution of nocturnal erectile response. In contrast, androgen administration had no effect on the nocturnal erections of a group of eugonadal men presenting with erectile dysfunction. Androgen administration to hypogonadal and eugonadal men had a general lack of effect on a series of psychometric test scores, which measure various aspects of cognitive functioning and personality. (Previous investigators had proposed that these test scores were correlated with circulating androgen levels). A case study is presented, reporting the lack of behavioural effect of oral testosterone undecanoate administration in an institutionalised hypogonadal man who had previously responded very aggressively to testosterone injections. The implications of these experimental findings are discussed in relation to the results of previous studies.

Suicide is a major cause of death worldwide, responsible for 1.5% of all mortality. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. This meta-analytic review aimed i) to estimate the strength and variability of the association between naturally fluctuating cortisol levels and suicidal behavior and ii) to identify moderators of this relationship. A systematic literature search identified 27 studies (N = 2226; 779 suicide attempters & 1447 non-attempters) that met the study eligibility criteria from a total of 417 unique records initially examined. Estimates of effect sizes (r) obtained from these studies were analysed using Comprehensive Meta-Analysis. In these analyses, we compared participants identified as having a past history of suicide attempt(s) to those with no such history. Study quality, mean age of sample and percentage of male participants were examined as potential moderators. Overall, there was no significant effect of suicide group on cortisol. However, significant associations between cortisol and suicide attempts were observed as a function of age. In studies where the mean age of the sample was below 40 years the association was positive (i.e., higher cortisol was associated with suicide attempts; r = .234, p < .001), and where the mean age was 40 or above the association was negative (i.e., lower cortisol was associated with suicide attempts; r = - .129, p < .001). These findings confirm that HPA axis activity, as indicated by age-dependent variations in cortisol levels, is associated with suicidal behavior. The challenge for theory and clinical practice is to explain the complete reversal of the association with age and to identify its clinical implications.

BACKGROUND: Elderly people who demonstrate memory impairment that falls short of dementia, are referred to as having amnestic Mild Cognitive Impairment (aMCI). AMCI patients have an elevated risk of developing dementia, although not all will do so. Clinical criteria for Alzheimer’s Disease (AD) and aMCI do not specify how impairment of a cognitive nature should be defined. The process of differentially diagnosing these conditions can be improved, if knowledge of neuropsychological measures that best discriminate between neurodegenerative and non-neurodegenerative cognitive impairment is used to implement diagnostic criteria for aMCI and AD. AIMS: We sought to 1) determine the frequency of aMCI referrals to our specialist memory clinic, 2) characterise the detailed neuropsychology of a group of patients with aMCI, 3) determine the utility in differential diagnosis and test-retest reliability of these neuropsychological measures, and 4) establish a subset of neuropsychological measures that were of prognostic utility in aMCI. METHODS: The case notes of 187 consecutive referrals received by our Royal Edinburgh Hospital memory assessment service across an 18-month period were reviewed retrospectively and numbers of patients fulfilling aMCI criteria were recorded. The baseline neuropsychological performances of 46 patients with aMCI, 20 patients with very early stage AD, 20 elderly patients with depressive symptoms and 24 healthy elderly participants were compared in order to determine their usefulness in differential diagnosis. AMCI participants were followed-up across an average of 4 years. Baseline neuropsychological performances of the aMCI dementia converters and aMCI non-converters were compared. Logistic regression analysis was applied to ascertain the predictive accuracy of a combination of these. RESULTS: One quarter of referrals received by our memory assessment service met criteria for aMCI, most of whom displayed additional neuropsychological impairments of a non-memory nature, all the while performing above the highest cut off points on even the most comprehensive dementia screening measures. A number of neuropsychological measures were highly sensitive and specific to early AD however, similar combinations of both high sensitivity and specificity to aMCI were not achieved. Forty one percent of patients presenting to our service who fulfilled criteria for aMCI, received a clinical diagnosis of dementia across an average 4-year period. Performances on a comprehensive cognitive screening measure and a measure of delayed word recognition accuracy at baseline, classified 74% of aMCI patients comprising our clinic sample in accordance with their prognostic fate. CONCLUSION: A significant proportion of patients presenting to specialist memory clinics display episodic and semantic memory/ or executive impairment that falls short of dementia and that is not detectable using traditional bedside screening measures. The vast majority of such patients (i.e. 72%) experience persisting or progressive cognitive impairment, and a significant proportion (41%) go on to receive a clinical diagnosis of dementia. The baseline neuropsychological performance of aMCI patients who do and do not develop dementia differs, and contributes over and above clinical information to the prediction of long-term diagnostic outcome. The high frequency with which aMCI is encountered in clinical practice, coupled with the minority of aMCI patients who experience resolution of their cognitive impairment, and the sensitivity and prognostic utility of several neuropsychological tasks, has implications for the clinical management of patients with aMCI.

The aim of this thesis was to expand the existing knowledge base concerning the profile of emotional processing that is associated with major depression, particularly in terms of socially important non-verbal stimuli (e.g. emotional facial expressions). Experiment one utilised a face-word variant of the emotional Stroop task and demonstrated that depressed patients (DP) did not exhibit a selective attention bias for sad faces. Conversely, the healthy controls (HC) were shown to selectively attend to happy faces. At recognition memory testing, DP did not exhibit a memory bias for depression-relevant words, but did demonstrate a tendency to falsely recognise depression-relevant words that had not been presented at encoding. Experiment two examined the pattern of autobiographical memory (ABM) retrieval exhibited by DP and HC in response to verbal (words) and non-verbal (images & faces) affective cues. DP were slower than HC to retrieve positive ABMs, but did not differ from HC in their retrieval times for negative ABMs. Overall, DP retrieved fewer specific ABMs than did the HC. Participants retrieved more specific ABMs to image cues than to words or faces, but this pattern was only demonstrated by the HC. Reduced retrieval of specific ABMs by DP was a consequence of increased retrieval of categorical ABMs; this tendency was particularly marked when the participants were cued with faces. During experiment three, DP and HC were presented with a series of faces and were asked to identify the gender of the person featured in each photograph. Overall, gender identification times were not affected by the emotion portrayed by the faces. Furthermore at subsequent recognition memory testing, DP did not exhibit MCM bias for sad faces. During experiment four, DP and HC were presented with videotaped depictions of 'realistic' social interactions and were asked to identify the emotion portrayed by the characters and to make inferences about the thoughts, intentions and beliefs of these individuals. Overall, DP were impaired in their recognition of happiness and in understanding social interactions involving sarcasm and deception. Correct social inference was significantly related to both executive function and depression severity. Experiment five involved assessing a group of eight patients that had undergone neurosurgery for chronic, treatment-refractory depression on the identical emotion recognition and social perception tasks that were utilised in experiment four. Relative to HC, surgery patients (SP) exhibited general deficits on all emotion recognition and social processing tasks. Notably, depression status did not appear to interact with surgery status to worsen these observed deficits. These findings suggest that the anterior cingulate region of the prefrontal cortex may play a role in correct social inference. Summary: Taken together the findings of the five experimental studies of the thesis demonstrate that, in general, biases that have been observed in DP processing of affective verbal material generalise to non-verbal emotional material (e.g. emotional faces). However, there are a number of marked differences that have been highlighted throughout the thesis. There is also evidence that biased emotional processing in DP requires explicit processing of the emotional content of the stimuli. Furthermore, a central theme of the thesis is that deficits in executive function in DP appear to be implicated in the impairments of emotional processing that are exhibited by these patients.

This thesis addressed the nature of arousal and its impact on human memory by assessing the degree to which response characteristics, stimulus characteristics, pharmacological and neurological characteristics affect memory for emotional material. Understanding the mechanisms by which emotions affect memory may contribute to attempts to ameliorate clinical disorders, which are characterized by intrusive traumatic memories. In experimental Chapter 2, frequency-matched words rated as highly arousing were remembered consistently better than low arousal rated words with a normal pattern of decay over a series of 4 recall intervals occurring over one week in a within-subject design. Galvanic skin responses to the same words that were high or low at the time of stimulus presentation did not predict memory at these intervals. Chapter 3 assessed the role of the central noradrenergic (NA) system in memory for emotional material. Pharmacological processes believed to occur at the time of arousal and which are believed to be involved in the encoding of specifically emotional memories were manipulated. It was predicted that NA re-uptake inhibition would result in an increase in memory for the emotional compared to neutral material. The study demonstrated a dose-dependent effect opposite to the predicted direction. The fourth experimental chapter studied the effects of physiological response characteristics alone on memory. Memory was assessed in subjects who demonstrated low physiological reactivity to images (high 'alexithymics') compared to controls (low 'alexithymics') but who did not demonstrate differences in subjective emotional responses. While differences in physiological reactivity existed between high and low alexithymics, no differences in memory were observed. In Chapter 5, free-recall memory for images combined with incongruent sounds was better than free-recall memory for images that were combined with congruent sounds. Presentations that were rated as unpleasant (low valence) and highly arousing were remembered better than other categories regardless of stimulus incongruity. Chapter 6 investigated hemispheric differences in emotional memory functioning in man. A patient with right amygdala damage showed evidence of an emotional but not neutral memory impairment over four tasks compared to age and education matched healthy controls. By contrast, another patient with damage to the left amygdala performed similarly to the controls on the same tasks. These findings, taken together indicate a) subjective rather than physiological responses to stimuli predict memory performance in healthy adults, b) the interaction of low valence (pleasantness) ratings and high arousal ratings is associated with superior recall in healthy adults, c) the effects of emotion on memory are not due to other stimulus characteristics such as distinctiveness d) that increasing the level of the neurotransmitter noradrenaline (modulated by emotional arousal) does not improve emotional memory and e) the right amygdala in humans may be more critical for emotional memory functioning than the left amygdala in humans.