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High smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique-based intervention for smoking cessation and depression/anxiety.This study was embedded within an ongoing randomized-controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open-ended questions about their quitting experience and perception of how the intervention aided their behaviour change.Five themes were identified. Acquiring an increased awareness of smoking patterns: participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies: participants described acquiring 'a couple of tricks up your sleeve' that were helpful in making smoking cessation feel more 'manageable'. Practitioner style as 'supportive but not lecture-y': participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions: participants expressed the importance of 'having someone that's checking in on you'. Having the opportunity to access the intervention at 'the right time': participants described the intervention as the 'push' that they 'needed'.Participants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants' mental health, and the opportunity to be offered smoking cessation treatment in a 'non-judgemental', 'supportive' environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety.Persons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.

Why do individuals engage in violence against the state? This research investigates the biological and environmental determinants of individual-level participation in political violence through the use of a Candidate Gene Association, gene-environment interaction, study. Existing research has demonstrated that variation in a specific gene (called MAO-A) is associated with aggression. However, relatively little scholarly attention has been paid to the interaction with the environment; specifically, the ways in which repressive political environments differentially incite acts of violence. Using original genetic, survey and experimental data collected on participants and non-participants of political violence, I find that under conditions of political repression, individuals with the low MAO-A genetic variant are significantly more likely to engage in acts of political violence. By examining both the genetic and environmental factors influencing political violence, the results make a significant contribution to our understanding of how genetic variation may lead to violence.

ImportanceTraditional observational epidemiological studies have consistently found an association between tobacco use, cannabis use and subsequent mental ill-health. However, the extent to which this association reflects an increased risk of new-onset mental ill-health is unclear and may be biased by unmeasured confounding.ObjectiveTo examine the association between cannabis use, tobacco use and risk of incident mood, anxiety, and psychotic disorders, and explore risk of bias.Data SourcesCINAHL, Embase, MEDLINE, PsycINFO and ProQuest Dissertation and Theses were searched from inception until November 2022, in addition to supplementary searches.Study SelectionLongitudinal studies assessing tobacco use and cannabis use and their association with incident mood, anxiety or psychotic disorders were included. Studies conducted in populations selected on health status (e.g., pregnancy) or other highly-selected characteristics (e.g., incarcerated persons) were excluded.Data Extraction and SynthesisA modified Newcastle Ottawa Scale was used to assess study quality. The confounder matrix and E-Values were used to assess potential bias due to unmeasured confounding. Summary risk ratios (RR) were calculated in random-effects meta-analyses using the generic inverse variance method.Main Outcome(s) and Measure(s)Exposures were measured via self-report and defined through status (e.g., current use) or heaviness of use (e.g., cigarettes per day). Outcomes were measured through symptom-based scales, interviews, registry codes and self-reported diagnosis or treatment. Effect estimates extracted were risk of incident disorders by exposure status.ResultsSeventy-five out of 27789 records were included. Random effects meta-analysis demonstrated a positive association between tobacco use and mood disorder (RR:1.39, 95%CI:1.30–1.47) and psychotic disorder (RR:3.45, 95%CI:2.63-4.53), but not anxiety disorder (RR:1.21, 95%CI:0.87–1.68). Cannabis use was positively associated with psychotic disorders (RR:3.19, 95%CI:2.07-4.90), but not mood disorders (RR:1.31, 95%CI:0.92-1.86) or anxiety disorders (RR:1.10, 95%CI:0.99-1.22). Confounder matrix and E-value assessment indicated estimates were moderately biased by unmeasured confounding.Conclusions and RelevanceThis systematic review and meta-analysis presents evidence for a longitudinal, positive association between both substances and incident psychotic disorders and tobacco use and mood disorders. There was no evidence to support an association between cannabis use and common mental health conditions. Existing evidence across all outcomes was limited by inadequate adjustment for potential confounders. Future research should prioritise methods allowing for stronger causal inference, such as Mendelian randomization and evidence triangulation.

INTRODUCTION: Improving Access to Psychological Therapies (IAPTs) Services could offer smoking cessation treatment to improve physical and psychological outcomes for service users, but it currently does not. This study aimed to understand participants' views and experiences of receiving a novel smoking cessation intervention as part of the ESCAPE trial (intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety). We used the Capability, Opportunity and Motivation Model of Behaviour (COM-B) to understand the (i) acceptability of the integrated smoking cessation treatment, (ii) views of psychological well-being practitioners' (PWPs) ability to deliver the smoking cessation treatment and (iii) positive and negative impacts of smoking cessation treatment.METHODS: This was a qualitative study embedded within a feasibility randomized-controlled trial (ESCAPE) in primary care services in the United Kingdom (IAPT). Thirty-six participants (53% female) from both usual care and intervention arms of the ESCAPE trial, including both quitters and nonquitters, were interviewed using semi-structured interviews. Data were analysed using a framework approach to thematic analysis, using the COM-B as a theoretical frame.RESULTS: Psychological Capability: Integrated smoking cessation treatment was acceptable and encouraged participants to reflect on their mental health. Some participants found it difficult to understand nicotine withdrawal symptoms.MOTIVATION: Participants were open to change during the event of presenting to IAPT. Some described being motivated to take part in the intervention by curiosity, to see whether quitting smoking would help their mental health. Physical Opportunity: IAPT has a natural infrastructure for supporting integrated treatment, but there were some barriers such as session duration and interventions feeling segmented. Social Opportunity: Participants viewed PWPs as having good interpersonal skills to deliver a smoking cessation intervention.CONCLUSION: People with common mental illness generally accepted integrated smoking cessation and mental health treatment. Smoking cessation treatment fits well within IAPT's structure; however, there are barriers to implementation.PATIENT OR PUBLIC CONTRIBUTION: Before data collection, we consulted with people with lived experience of smoking and/or mental illness and lay public members regarding the aims, design and interview schedules. After analysis, two people with lived experience of smoking and mental illness individually gave feedback on the final themes and quotes.

Background Excessive alcohol use is common in young people and is associated with a range of adverse consequences including an increased risk of depression. Alcohol interventions are known to be effective in young people, however it is not known if these interventions can also improve depression. Objective To investigate whether psychosocial interventions principally targeting excessive alcohol use in young people reduce depression symptoms compared to controls. Design We conducted a systematic review and meta-analysis of controlled intervention trials, that measured depression symptoms at follow-up. We used a generic inverse variance random effect meta-analysis to pool the standardised mean difference in change in depression symptoms from baseline to follow-up between intervention and control arms. We used I2 to measure heterogeneity, the Cochrane tool for randomised trials to assess risk of bias, and Egger’s tests to assess small study bias. Data sources APA PsycNET, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase (including MEDLINE), and clinicaltrials.gov were searched for relevant studies published from inception to December 2020. Reference lists of studies were also searched, and authors contacted where articles presented insufficient data. Study eligibility criteria Intervention studies that primarily targeted existing excessive alcohol use in young people (aged 10 to 24) and assessed depression outcomes at baseline with a minimum of four-week follow-up. Results Five studies were included in the meta-analysis. Interventions targeting excessive alcohol use were associated with a reduction in depression symptoms from baseline to follow-up when compared to control, standardised mean difference = − 0.26, and 95% confidence interval [− 0.41, − 0.12], p Conclusions This study found evidence that interventions primarily targeting excessive alcohol use can reduce depression symptoms in young people. However, this finding should be taken with caution given concerns about risk of bias in all studies. More research is needed to examine whether these findings generalise beyond populations of undergraduate students primarily living in high income countries. Trial registration PROSPERO registration number: CRD42020177260.

A number of explanations have been advanced for why soldiers commit acts of sexual violence in wartime, yet we have little understanding of why some rebels refrain from sexual violence. We examine ...

While the conflict literature has examined the use of forced recruitment in conflict, the question remains why groups would choose to do so when forced recruits require expensive coercion and time ...

BackgroundHigh smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these integrated interventions have not been investigated.AimsThis qualitative study aimed to investigate participants’ subjective experiences of the mechanisms underlying change in smoking behaviour following an integrated CBT-based intervention for smoking cessation and depression/anxiety.MethodsThis study was embedded within an ongoing randomised controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semi-structured interviews were conducted with 15 IAPT service users and data were analysed using thematic analysis.ResultsFive themes were identified: (1) acquiring an increased awareness of smoking patterns, (2) developing individualised strategies, (3) practitioner style as “supportive but not lecture-y” (4) importance of regular sessions, and (5) having the opportunity to access intervention at “the right time”.ConclusionsThese findings further our understanding of the mechanisms of change towards smoking cessation in this integrated intervention and highlight the need to emphasise and embed these components in manualised interventions to optimise therapeutic benefits and reduce smoking prevalence in people with depression/anxiety.Relevance statementThis study qualitatively investigated mechanisms underlying change in smoking behaviour following an integrated intervention for depression/anxiety and smoking cessation. Research shows interventions integrating smoking cessation and mood management are more effective than smoking cessation interventions alone; however further investigation is needed to understand mechanisms of change for integrated interventions. The current results identified key factors that were important for participants in the integrated intervention to reduce smoking. An improved understanding of mechanisms underlying change in smoking behaviour helps to identify therapist characteristics and treatment components that improve therapeutic outcomes which future research could investigate using a randomised controlled trial design.

BackgroundHealth warning labels on tobacco packaging are a cost-effective means of health risk communication. However, while an extensive range of physical health risks are well-portrayed via current tobacco health warnings in the UK, there are none that currently portray the negative impact of smoking on mental health.Aims(i) develop novel mental health warning labels for tobacco packaging and (ii) test perceptions of these warnings in smokers and non-smokers, with and without mental health problems.MethodsSix mental health warning labels were developed with a consultancy focus group. These warning labels were tested in an online randomised experiment, where respondents (N = 687) rated six Mental Health Warning Labels (MHWLs) and six Physical Health Warning Labels (PHWLs) on measures of perceived effectiveness, believability, arousal, valence, acceptability, reactance and novelty of information.ResultsMHWLs were perceived as low to moderately effective (mean = 4.02, SD = 2.40), but less effective than PHWLs (mean = 5.78, SD = 2.55, p < 0.001, ηp2 = 0.63). MHWLs were perceived as less believable, arousing, unpleasant, and acceptable than PHWLs. MHWLs evoked more reactance and were rated as more novel. Perceptions of MHWLs did not differ in people with and without mental health problems except for reactance and acceptability, but consistent with the PHWL literature, perceptions of MHWLs differed between non-smokers and smokers.ConclusionMHWLs could be an effective means to communicate novel information about the effects of smoking on mental health. MHWLs are perceived as less effective, believable, arousing, unpleasant, and acceptable than PHWLs, but MHWLs evoke more reactance and are rated as more novel.

Background Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants’ experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study. Methods In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice. Results Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis. Conclusions We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.

The international community often calls for negotiations in civil wars. Yet, we have limited understanding of when and why specific rebels enter into negotiations. The emergence of a new leader in a rebel group can provide an opportunity for the state seeking to end war, but this is conditional on how leaders take power. Rebel leaders who come to power through a local selection process (such as an election) provide information to the state about the likely cohesion of the rebel group. This affects state perceptions of the viability of a rebel group as a bargaining partner in civil war negotiations. Using original data on rebel leaders in civil wars, we show that new leaders coming to power through a local selection process are more likely to get to the negotiating table than leaders coming to power in other ways. We find that the election of a rebel group leader has a particularly strong and positive effect on the chance of getting to the table. Rebel leaders that founded their own group or brought together disparate rebels to create a single group are less likely to get to the negotiating table. This article advances our understanding of conflict dynamics by offering a novel argument of rebel leader ascension and its impact on conflict bargaining and has critical implications for parties external to the conflict interested in conflict resolution. External actors seeking to facilitate lasting peace may benefit from observing patterns of rebel leadership.

Background: There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self‐medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. Objectives: To examine the association between tobacco smoking cessation and change in mental health. Search Methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously‐conducted non‐Cochrane review where searches were conducted from database inception to 13 April 2012. Selection Criteria: We included controlled before‐after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow‐up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. Data Collection and Analysis: We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow‐up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS‐I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow‐up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta‐analyses we used a generic inverse variance random‐effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub‐populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non‐randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose‐response gradient). Main Results: We included 102 studies representing over 169,500 participants. Sixty‐two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty‐three studies provided data on change in mental health, 10 were included in meta‐analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD −0.28, 95% CI −0.43 to −0.13; 15 studies, 3141 participants; I2 = 69%; low‐certainty evidence); depression symptoms: (SMD −0.30, 95% CI −0.39 to −0.21; 34 studies, 7156 participants; I2 = 69%' very low‐certainty evidence); mixed anxiety and depression symptoms (SMD −0.31, 95% CI −0.40 to −0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time‐varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD −0.19, 95% CI −0.34 to −0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). Authors' Conclusions: Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low‐ to moderate‐certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time‐varying confounding would strengthen the evidence in this area.

Self-determination claims have abounded in the international system since the end of World War II. But these claims have not emerged everywhere. About half of the states in the international system face some challenge related to self-determination today. Why do some states face these demands while others do not? We argue that ethno-national self-determination is one of many identities with which individuals can find affinity. While an international norm related to self-determination has developed globally, its use as a basis for political claims has diffused regionally. Diffusion of self-determination occurs through observation of others using self-determination as a basis of organization, generating a sense of legitimacy, sensitivity to related grievance, and perceptions of tangible benefits related to self-determination identification. We test this empirically on global data on self-determination claims from 1960 to 2005 and find evidence of spatial diffusion, suggesting that self-determination is, to some extent, contagious.

De Dreu and Gross's distinction between attack and defense is complicated in real-world conflicts because competing leaders construe their position as one of defense, and power imbalances place status quo challengers in a defensive position. Their account of defense as vigilant avoidance is incomplete because it avoids a reference to anger which transforms anxious avoidance into collective and unified action.

Many studies highlight the role that international intervention can play in prolonging civil wars. Yet, direct military intervention is just one way that external actors become involved in civil conflicts. In this article, a model is developed and analyzed that shows that when the government is unsure about how external support to the rebels will help rebel war-making capacity, it is the government that will continue fighting rather than settle the dispute. Different types of external support to rebels influence their fighting capacity differently, and some types of support create uncertainty about how new resources will translate into war-making ability. Specifically, more fungible sources of support (such as direct financial support) generate the most uncertainty for states as they attempt to estimate the effect of support to rebels on the conflict. Increased uncertainty inhibits bargained settlement, and disputes characterized by fungible external support are less likely to end than those where rebels receive different kinds of support. Empirical analyses demonstrate strong support for this argument; rebels that receive highly fungible external support (money and guns) are less likely to see conflict termination than rebels that do not.

Preschoolers' (N = 143) patterns of emotional expressiveness, emotion regulation, and emotion knowledge were assessed. Their contributions to social competence, as evidenced by sociometric likability and teacher ratings, were evaluated via latent variable modeling, both concurrently and across time. Moderation of key results by age and sex was also explored. Emotional competence assessed at 3 to 4 years of age contributed to both concurrent and kindergarten social competence. Even early in the preschool period, contributions of emotional competence to social competence have long-term implications.

The international community frequently calls for negotiations when civil wars break out, encouraging combatants to come to the table to resolve their differences. Despite the critical role that getting to the table plays in the negotiated settlement of civil conflicts, little attention has been paid to the question of which rebels get negotiated with in the first place. We argue that the character of rebel leadership plays a key role in determining which rebels get to the table. Specifically, the election of rebel leaders provides a signal to the state of the legitimacy of the leader and coherence of the rebel group. Consequently, these leaders are better equipped to make promises on behalf of rebel constituents and are more likely to be negotiated with than leaders who came to power through other means. Using an original dataset on rebel leadership from 1989-2011 and two-stage modeling, we demonstrate empirically that elected rebel leaders are more likely to be negotiated with in the first place and that, in turn, these negotiations are more likely to lead to successful conflict termination. Survival analysis shows that leaders that are selected through some democratic process see negotiations and conflict end sooner than all other types of rebel leaders.