Search

University students are at risk of experiencing mental health problems during the transition from home to university. This transition can also adversely affect their diet quality. This review aims to examine bidirectional associations from observational studies regarding the influence of diet quality on the mental health of university students, and vice versa. The databases PubMed, CINAHL, EMBASE, PsycINFO, The Cochrane Library and Web of Science were searched using relevant search terms. The searches were last updated on 15 July 2022. Majority of studies (36 out of 45) found that good diet quality of students was associated with better mental health in terms of depression, anxiety, stress and overall general mental well-being. Moreover, majority of studies (19 out of 23) found that stress and anxiety of students were associated with poorer diet quality. The effect sizes observed were generally small–moderate. Healthy diets of students have been associated with better mental health in terms of depression, anxiety, stress or other mental health issues. Stress experienced by university students has been associated with unhealthy diets. There are implications for health education research, as interventions to improve diet quality at the university level could reduce mental health issues; additionally, interventions to support students under stress may lead to healthier dietary habits when living on campuses. Randomized controlled trials and intervention studies are needed to further investigate these implications.

Background An estimated 280 million individuals suffer from depression. Brief group interventions in Primary Healthcare Centres (PHCs) are recommended. One goal of these interventions is to educate people about healthy lifestyle habits, as they prevent the development of depression. This study aims to analyse the one-year follow-up results about the effectiveness of a Lifestyle Modification Programme (LMP) and an LMP plus Information and Communication Technologies (LMP + ICTs) when compared to Treatment as Usual (TAU). Methods We conducted an open-label, multicentre, pragmatic, randomised clinical trial. A total of 188 individuals that visited a general practitioner and met the inclusion criteria were randomised. LMP consisted of six weekly 90-minute group sessions focusing on lifestyle improvement. LMP + ICTs was a hybrid of the LMP format with the inclusion of a wearable smartwatch. We used linear mixed models (with a random intercept and an unstructured covariance) to evaluate the effectiveness of the interventions, and an intention-to-treat analysis and Multiple Imputation technique for handling missing data. Results LMP + ICTs showed a statistically significant reduction on depressive symptoms (b = −2.68, 95 % CI = [−4.239, −1.133] p = .001) and sedentarism (b = −37.38, 95 % CI [−62.930, −11.833], p = .004) compared to TAU. Limitations Most of the dropouts were due to time restrictions. Conclusions In long-term, LMPs plus ICTs administered in PHCs to people suffering from depression were effective in reducing depressive symptomatology and sedentarism comparing to TAU. More research is needed to enhance adherence to lifestyle recommendations. These promising programmes could be easily implemented in PHCs. Trial registration number: ClinicalTrials.gov Registry (NCT03951350).

Background Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age‐inappropriate levels of inattention, hyperactivity, and impulsivity, and is associated with long‐term social, academic, and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Research has shown that children and adolescents with ADHD have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega‐3 PUFA. These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. This review is an update of a previously published Cochrane Review. Overall, there was little evidence that PUFA supplementation improved symptoms of ADHD in children and adolescents. Objectives To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents. Search methods We searched 13 databases and two trials registers up to October 2021. We also checked the reference lists of relevant studies and reviews for additional references. Selection criteria We included randomised and quasi‐randomised controlled trials that compared PUFA with placebo or PUFA plus alternative therapy (medication, behavioural therapy, or psychotherapy) with the same alternative therapy alone in children and adolescents (aged 18 years and under) diagnosed with ADHD. Data collection and analysis We used standard Cochrane methods. Our primary outcome was severity or improvement of ADHD symptoms. Our secondary outcomes were severity or incidence of behavioural problems; quality of life; severity or incidence of depressive symptoms; severity or incidence of anxiety

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures. This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy. The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP. The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted.

Objectives: The majority of people with mild to moderate dementia in the United Kingdom (UK) are cared for by informal caregivers (CGs), usually spouses and close family members. However, surprisingly little is known about the influence of the dyadic relationship in regard to an individual’s own help-seeking once receiving a diagnosis of dementia. Using the conceptual framework of the Self-Regulatory Model (SRM), the aim of this study was to examine the illness perceptions of people with early-stage dementia and their CG in relation to their own help- seeking. Also, the effect of the relationship between both members of the dyad on their own illness perceptions with their own help-seeking intentions was examined. Methods: A cross-sectional study of 56 dyads (person with dementia and CG) applied the five dimensions of the Illness Perception Questionnaire (IPQ-R) to assess illness perceptions of dementia and the General Help Seeking Questionnaire (GHSQ) to measure help-seeking. Dyads were recruited from 9 community mental health teams for older adults from an NHS trust in the UK. Findings: To answer the research question a systematic literature review of 14 studies revealed that an individual’s illness perceptions of dementia were related to their own cultural beliefs, acceptance, stigma, and experiences of dementia services, and that these perceptions influenced their own help-seeking intentions. In response to the literature review, an Actor Partner Independence Model (APIM) analysis of the person with dementia and their carers illness perceptions revealed a significant actor effect for identity with help-seeking for the person with dementia and for physical and behaviour cause with help-seeking for the CG. However, there were no partner effects across dyads, both between and within the person with dementia and the CG. Conclusion: This is the first study to utilise the IPQ-R with people living with dementia. Examining illness perceptions with help-seeking, the modif

In the western world, it is well known that the unequal distribution of power and resources unjustly impacts on peoples’ opportunity to lead their best lives, and on their health and recovery. Health inequalities can be observed across the border and they have a significant role to play for the 1billion people currently suffering with mental health difficulties and suicidality. Despite wide acknowledgement of the relationship between socioeconomic determinants and mental health ranging from research to politics, current efforts have not been able to put a halt to these issues that are steadily increasing to affect larger percentage of the world population. Partly this could be attributed to a lack of understanding and knowledge about the mechanism underlying the relationship between the socioeconomic environment and mental health. The present thesis is framed within a critical realist research paradigm and consists of four studies (a systematic review, a secondary public health data analysis, and two cross-sectional analyses of primary data). It aims to explore the potential role of cognitive ruminative thinking as a mediator in the relationship between individual socioeconomic indicators (both absolute and relative) and a range of mental health outcomes (depressive, (hypo-)manic mood, hallucinations, suicidality). It examines this for different subtypes of rumination (negative, positive, transdiagnostic), which allows for a more comprehensive understanding. The systematic review finds mixed evidence about the relationship of positive rumination and mood, but in doing so indicates the need to include positive rumination in the mediational model built. The public health secondary data offer the opportunity to test the mediational in a large general population sample. The findings are supportive of the hypothesized mediational role and thus the next two studies use data from a built-for-purpose survey that leads to the examination of a series of iterations of the medi

Background An estimated 280 million individuals suffer from depression. Brief group interventions in Primary Healthcare Centres (PHCs) are recommended. One goal of these interventions is to educate people about healthy lifestyle habits, as they prevent the development of depression. This study aims to analyse the one-year follow-up results about the effectiveness of a Lifestyle Modification Programme (LMP) and an LMP plus Information and Communication Technologies (LMP + ICTs) when compared to Treatment as Usual (TAU). Methods We conducted an open-label, multicentre, pragmatic, randomised clinical trial. A total of 188 individuals that visited a general practitioner and met the inclusion criteria were randomised. LMP consisted of six weekly 90-minute group sessions focusing on lifestyle improvement. LMP + ICTs was a hybrid of the LMP format with the inclusion of a wearable smartwatch. We used linear mixed models (with a random intercept and an unstructured covariance) to evaluate the effectiveness of the interventions, and an intention-to-treat analysis and Multiple Imputation technique for handling missing data. Results LMP + ICTs showed a statistically significant reduction on depressive symptoms (b = −2.68, 95 % CI = [−4.239, −1.133] p = .001) and sedentarism (b = −37.38, 95 % CI [−62.930, −11.833], p = .004) compared to TAU. Limitations Most of the dropouts were due to time restrictions. Conclusions In long-term, LMPs plus ICTs administered in PHCs to people suffering from depression were effective in reducing depressive symptomatology and sedentarism comparing to TAU. More research is needed to enhance adherence to lifestyle recommendations. These promising programmes could be easily implemented in PHCs. Trial registration number: ClinicalTrials.gov Registry (NCT03951350).

University students are at risk of experiencing mental health problems during the transition from home to university. This transition can also adversely affect their diet quality. This review aims to examine bidirectional associations from observational studies regarding the influence of diet quality on the mental health of university students, and vice versa. The databases PubMed, CINAHL, EMBASE, PsycINFO, The Cochrane Library and Web of Science were searched using relevant search terms. The searches were last updated on 15 July 2022. Majority of studies (36 out of 45) found that good diet quality of students was associated with better mental health in terms of depression, anxiety, stress and overall general mental well-being. Moreover, majority of studies (19 out of 23) found that stress and anxiety of students were associated with poorer diet quality. The effect sizes observed were generally small–moderate. Healthy diets of students have been associated with better mental health in terms of depression, anxiety, stress or other mental health issues. Stress experienced by university students has been associated with unhealthy diets. There are implications for health education research, as interventions to improve diet quality at the university level could reduce mental health issues; additionally, interventions to support students under stress may lead to healthier dietary habits when living on campuses. Randomized controlled trials and intervention studies are needed to further investigate these implications.

Some mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first studies of this type. In a randomized controlled trial (RCT), 579 children aged 7-10 (M = 8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent class analysis and linear mixed effects models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. A 3-class solution demonstrated best fit for the NEO: MN&MC = moderate neuroticism and conscientiousness (n = 284); HN&LC = high neuroticism, low conscientiousness (n = 83); LN&HC = low neuroticism, high conscientiousness (n = 70). Per parent-reported symptoms, children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid in treatment selection for children with ADHD, though additional research on this topic is needed.

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted.

Background: Depression symptoms are prevalent in the general population, and their onset and continuation may be related to biological and psychosocial factors, many of which are related to lifestyle aspects. Health promotion and lifestyle modification programmes (LMPs) may be effective on reducing the symptoms. The objective of this study was to analyse the clinical effectiveness of a LMP and a LMP plus Information and Communication Technologies (LMP+ICTs), when compared to Treatment as Usual (TAU) over 6 months. The interventions were offered as an adjuvant treatment delivered in Primary Healthcare Centres (PHCs) for people with depression symptoms. Methods: We conducted an open-label, multicentre, pragmatic, randomised clinical trial. Participants were recruited from several PHCs. Those participants visiting general practitioner (GP) for any reason, who also met the inclusion criteria [scoring 10 to 30 points on the Beck II Self-Applied Depression Inventory] were invited to take part in the study. LMP consisted of six weekly 90-minute group sessions focused on improving lifestyle. LMP + ICTs replicated the LMP format, plus the addition of a wearable smartwatch to measure daily minutes walked and sleep patterns. A total of 188 participants consented to participate in the study and were randomised. We used linear mixed models, with a random intercept and an unstructured covariance to evaluate the impact of the interventions compared to TAU. Results: Both interventions showed a statistically significant reduction on depressive symptoms compared to TAU (b = -3.38, 95% CI= [-5.286, -1.474] p < 0.001 and b = -4.05, 95% CI= [-5.919, -2.197], p < 0.001). These reductions imply a moderate effect size. In the LMP+ICTs there was a significant increase regarding minutes walking per week (b = 99.77) and adherence to Mediterranean diet (b = .702). In the LMP there was a significant decrease regarding bad sleep quality (b = -1.24). Conclusion: LMPs administered in PHCs to peopl

This thesis is comprised of a systematic literature review, an empirical research project and a critical appraisal. The systematic literature review offers a narrative synthesis of the published evidence regarding a relationship between childhood abuse and one’s sense of belonging/social connectedness, in the context of Joiner’s Interpersonal Psychological Theory of Suicide. A total of 13 papers were included in this review and findings suggest that experiencing childhood abuse and a reduced sense of belonging/social connectedness are associated. The literature review also offers an evaluation of the current measures used in childhood abuse/belongingness studies. As a result, recommendations are made as to the feasibility, acceptability and reliability of measures used in future research. The empirical research paper explores the relationship between intolerance of uncertainty and thwarted belongingness in individuals who self-report a BD diagnosis. Data was collected from 169 participants using an online survey in regards to demographic and clinical information, current depressive/(hypo)manic symptoms, belonging, intolerance of uncertainty and stigma. Using a linear regression analysis, findings showed that intolerance of uncertainty (alongside experiencing a current mood episode) was significantly associated with thwarted belongingness. Considering these findings, it is possible that existing, evidence-based interventions for intolerance of uncertainty can be used to tackle feelings of thwarted belongingness in clinical practice. The critical appraisal explores the findings of the previous two sections in the context of attachment and offers a critique of the current use of psychiatric diagnosis to lead clinical and research developments.

Bipolar Disorder (BD) is a complex mood disorder that is often treated pharmacologically to reduce patient symptoms and the risk of relapse. Medication though is only partially effective, with most individuals continuing to experience on-going symptoms. This has resulted in interest in the benefits of psychological approaches delivered as adjuncts to pharmacotherapies. Psychoeducation (PE) is an example of a psychological approach which has been demonstrated to be effective in BD, reducing the number of patient relapses, with positive outcomes being linked to increased levels of intervention usage. However, individuals with BD have been demonstrated to have high rates of intervention non-usage. This study investigated participant demographic and clinical characteristics, to discover if they correlated with usage levels in PE interventions for BD when delivered by digital or face-toface modalities. A quantitative systematic literature review of 39 studies examined the clinical and demographic characteristics of participants in adjunctive PE interventions for BD. This was to determine if these characteristics differed between users of individual, group and online delivery modalities. An empirical study, consisting of a secondary analysis of 3 studies, delivered by two online and one group modality was also conducted. Measures of demographic and clinical characteristics were extracted and used to examine predictors of PE intervention usage for BD via the number of sessions attended. The literature review showed that numbers of female participants in PE interventions were significantly higher than males across all delivery modalities. In the online studies, higher levels of regular commitments due to work, family and other responsibilities, were significantly associated with greater intervention usage. In the empirical study, increased usage of group PE was linked to increasing age and higher levels of education. No significant correlations were observed in the online s

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted.

Objective: To evaluate short forms of free self-report mania and depression scales, evaluating their reliability, content coverage, criterion validity, and diagnostic accuracy. Method: Youths age 11 to 18 years seeking outpatient mental health services at either an Academic medical clinic (N=427) or urban Community mental health center (N=313), completed the General Behavior Inventory (GBI) and other rating scales. Youths and caregivers completed semi-structured interviews to establish diagnoses and mood symptom severity, with GBI scores masked during diagnosis. Ten- and seven-item short forms, psychometric projections, and observed performance were tested first in the Academic sample and then externally cross-validated in the Community sample. Results: All short forms maintained high reliability (all alphas >.80 across both samples), high correlations with the full length scales (r .85 to .96), excellent convergent and discriminant validity with mood, behavior, and demographic criteria, and diagnostic accuracy undiminished compared to using the full length scales. Ten-item scales showed advantages in terms of coverage; the 7 Up showed slightly weaker performance. Conclusions: Present analyses evaluated and externally cross-validated short forms that maintain high reliability and content coverage, and show strong criterion validity and diagnostic accuracy – even when used in an independent sample with very different demographics and referral patterns. The short forms appear useful in clinical applications including initial evaluation, as well as in research settings where they offer an inexpensive quantitative score. Short forms are available in more than two dozen languages. Future work should further evaluate sensitivity to treatment effects and cultural invariance.

Study objectives Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. Methods PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a “hierarchy of evidence”. Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results 25 papers reporting on over 398 people’s experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. Conclusions This metasynthesis gave voice to user experiences of PAP, revealing barriers to PAP use at a healthcare service level across the world. The findings highlight ways in which services may be able to address these barriers to enhance PAP use.

Background. According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, “gist” reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, “verbatim” reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist “values” mediate the role of “categorical gist”. Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships. Methods. Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception. Results. Mediational models indicated that (a) Gist Values mediated Categorical Gist’s effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not. Limitations. Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the in-patient generalizability of the results. Conclusions. The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT’s functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.

Background: As the number of people with dementia increases, more families will be affected by the daily challenges of providing effective support, given its current incurable status. Once individuals are diagnosed with dementia, the earlier they access support the more effective the outcome. However once people receive a diagnosis, how they make sense of their dementia can impact on their help seeking intentions. Exploring the illness beliefs of people with dementia and their caregivers and this relationship to help seeking may identify how best to facilitate early support. Aims: To systematically obtain and critically review relevant studies on the relationship between illness perceptions and help seeking of people with dementia and their caregivers. Method: A systematic search was conducted and included both quantitative and qualitative studies. The Initial search was conducted in October 2018, with an adjacent search conducted in April 2020. Findings: A total of 14 articles met the inclusion criteria. Conceptually the studies examined the association of illness perceptions and help seeking post diagnosis and revealed that people living with dementia and their caregivers sought help when symptoms became severe. Components of Illness perceptions revealed that lack of knowledge, cultural beliefs, complexity of the health care system, threat to independence and acceptance were identified as major factors for delaying help seeking. Conclusion: Although research interest in the area of illness perceptions and their impact on help seeking for dementia is increasing, further work is needed to understand this area, particularly regarding the influence of the relationship between the person with dementia and their caregiver.

Introduction Circadian rhythms shift toward an evening preference during adolescence, a developmental period marked by greater focus on the social domain and salience of social hierarchies. The circadian system influences maturation of cognitive architecture responsible for motivation and reward, and observation of responses to reward cues has provided insights into neurocognitive processes that underpin adolescent social development. The objective was to investigate if circadian phase of entrainment (chronotype) predicted both reward-related response inhibition and social status, and to explore if mediator and moderator relationships existed between chronotype, reward processing and social status outcomes. Methods Participants were 75 adolescents aged 13-14 years old (41 females) who completed an eye tracking paradigm that involved an inhibitory control task (antisaccade task) within a non-social reward (Card Guessing Game) and a social reward (Cyberball Game) context. Chronotype was calculated from weekend midsleep and grouped into Early, Intermediate and Later terciles. Participants indicated subjective social status compared to peers in seven domains. Results An Intermediate and Later chronotype predicted improved inhibitory control in the social versus non-social reward context. Chronotype also predicted higher perceived social status in two domains (powerful, troublemaker). Intermediate chronotypes reported higher ‘Powerful’ status whereas Later chronotypes were higher on ‘Troublemaker’. Improved social reward-related performance predicted only the higher powerful scores and Chronotype moderated this relationship. Improved inhibitory control to social reward predicted higher subjective social status in the Intermediate and Later chronotype group, an effect that was absent in the Early group. Conclusion This behavioural study found evidence that changes toward a later phase of entrainment predicts social facilitation effects on inhibitory control and higher per

Background: Difficulties with decision making and risk taking in individual with Bipolar Disorder (BD) have been associated with mood episodes. However, there is limited information about these experiences during euthymia, the mood state where people with BD spent the majority of their time. Aims: To examine how individuals with BD consider risk in everyday decisions during their euthymic phase. Method: We conducted a qualitative study that used semi-structured audio recorded interviews. Eight euthymic participants with confirmed BD were interviewed, and we used Interpretative Phenomenological Analysis to analyse the data. Results: We identified four themes. The first theme, “Who I Really Am”, involves the relationship between individual identity and risks taken. The second theme, “Taking Back Control of my Life”, explored the relationship between risks taken as participants strove to keep control of their lives. The third theme, “Fear of the ‘What Ifs’”, represents how the fear of negative consequences from taking risks impacts risk decisions. Finally, the fourth theme, “The Role of Family and Friends”, highlights the important role that a supporting network can have in their lives in the context of taking risks. Conclusions: The study highlights aspects that can impact on an individual with BD’s consideration of risk during euthymia. Identity, control, fear and support all play a role when a person considers risk in their decision-making process, and they should be taken into consideration when exploring risk with individuals with BD in clinical settings, and inform the design of future interventions.

Study objectives Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. Methods PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a “hierarchy of evidence”. Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results 25 papers reporting on over 398 people’s experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. Conclusions This metasynthesis gave voice to user experiences of PAP, revealing barriers to PAP use at a healthcare service level across the world. The findings highlight ways in which services may be able to address these barriers to enhance PAP use.

Background: As the number of people with dementia increases, more families will be affected by the daily challenges of providing effective support, given its current incurable status. Once individuals are diagnosed with dementia, the earlier they access support the more effective the outcome. However once people receive a diagnosis, how they make sense of their dementia can impact on their help seeking intentions. Exploring the illness beliefs of people with dementia and their caregivers and this relationship to help seeking may identify how best to facilitate early support. Aims: To systematically obtain and critically review relevant studies on the relationship between illness perceptions and help seeking of people with dementia and their caregivers. Method: A systematic search was conducted and included both quantitative and qualitative studies. The Initial search was conducted in October 2018, with an adjacent search conducted in April 2020. Findings: A total of 14 articles met the inclusion criteria. Conceptually the studies examined the association of illness perceptions and help seeking post diagnosis and revealed that people living with dementia and their caregivers sought help when symptoms became severe. Components of Illness perceptions revealed that lack of knowledge, cultural beliefs, complexity of the health care system, threat to independence and acceptance were identified as major factors for delaying help seeking. Conclusion: Although research interest in the area of illness perceptions and their impact on help seeking for dementia is increasing, further work is needed to understand this area, particularly regarding the influence of the relationship between the person with dementia and their caregiver.

ObjectiveMothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers' personality traits and own ADHD symptoms could also affect parenting stress.Method430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers' group and maternal personality/ADHD symptoms related to parenting stress.ResultsCompared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers' group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers.ConclusionPersonality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.

Accelerometry data has been widely used to measure activity and the circadian rhythm of individuals across the health sciences, in particular with people with advanced dementia. Modern accelerometers can record continuous observations on a single individual for several days at a sampling frequency of the order of one hertz. Such rich and lengthy data sets provide new opportunities for statistical insight, but also pose challenges in selecting from a wide range of possible summary statistics, and how the calculation of such statistics should be optimally tuned and implemented. In this paper, we build on existing approaches, as well as propose new summary statistics, and detail how these should be implemented with high frequency accelerometry data. We test and validate our methods on an observed data set from 26 recordings from individuals with advanced dementia and 14 recordings from individuals without dementia. We study four metrics: Interdaily stability (IS), intradaily variability (IV), the scaling exponent from detrended fluctuation analysis (DFA), and a novel nonparametric estimator which we call the proportion of variance (PoV), which calculates the strength of the circadian rhythm using spectral density estimation. We perform a detailed analysis indicating how the time series should be optimally subsampled to calculate IV, and recommend a subsampling rate of approximately 5 minutes for the dataset that has been studied. In addition, we propose the use of the DFA scaling exponent separately for daytime and nighttime, to further separate effects between individuals. We compare the relationships between all these methods and show that they effectively capture different features of the time series.

Background Advanced cancer affects people’s lives, often causing stress, anxiety and depression. Peer mentor interventions are used to address psychosocial concerns, but their outcomes and effect are not known. Our objective was to determine the feasibility of delivering and investigating a novel peer mentor intervention to promote and maintain psychological wellbeing in people with advanced cancer. Methods A mixed methods design incorporating a two-armed controlled trial (random allocation ratio 1:1) of a proactive peer mentor intervention plus usual care, vs. usual care alone, and a qualitative process evaluation. Peer mentors were recruited, trained, and matched with people with advanced cancer. Quantitative data assessed quality of life, coping styles, depression, social support and use of healthcare and other supports. Qualitative interviews probed experiences of the study and intervention. Results Peer mentor training and numbers (n = 12) met feasibility targets. Patient participants (n = 12, from 181 eligible who received an information pack) were not recruited to feasibility targets. Those who entered the study demonstrated that intervention delivery and data collection were feasible. Outcome data must be treated with extreme caution due to small numbers, but indicate that the intervention may have a positive effect on quality of life. Conclusions Peer mentor interventions are worthy of further study and researchers can learn from these feasibility data in planning participant recruitment and data collection strategies. Pragmatic trials, where the effectiveness of an intervention is tested in real-world routine practice, may be most appropriate. Peer mentor interventions may have merit in enabling survivors with advanced cancer cope with their disease.

Short Term Psychodynamic Psychotherapy (STPP) has been demonstrated as an effective treatment for several mental health difficulties. However, its implementation in secondary mental health services in the National Health Service (NHS) is scarce. The aim of this study was to bridge the gap between controlled trials and practice-based evidence, by exploring an initial estimate of the therapeutic effects of this intervention as well as its safety in a secondary care NHS community mental health setting. Method: The study followed a quantitative case series design. Eight clients with complex, enduring mental health difficulties, supported by a community secondary mental health service received a course of STPP. They completed outcome measures at the start, at the end and eight-weeks following completion of therapy. Results: All participants but one completed the therapy and attendance rates were high (>75%). No adverse effects were reported. All participants but two reported improvement in the CORE-OM, BSI and the PHQ-9 and these were maintained at follow-up. Conclusions: The results suggested that STPP was a safe and acceptable intervention, that may have contributed to clinical and reliable improvement for 4 participants, non-reliable improvement for 2 and non-reliable deterioration for one participant who finished the treatment.

Background People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. Objectives To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. Design The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. Setting Nursing homes in England providing care for people with dementia. Participants Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. Intervention Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. Main outcome measures The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data – health economic outcomes, medication/service use and intervention activity. Results Phase 1 (realist review; 86 papers) iden

BACKGROUND: Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. METHODS: A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. RESULTS: One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. CONCLUSION: Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.

Background: Caregivers of children with asthma are at higher risk of experiencing mental health difficulties and lower quality of life than caregivers of healthy children. Mentalizing is a psychological construct that defines the ability of understanding one’s own and others’ states of mind. Poor levels of mentalizing are strongly associated with a wide range of mental health difficulties such as depression, anxiety or emotional dysregulation. This cross-sectional study is the first to examine the associations between mentalizing and mental health in a sample of caregivers of children with asthma. Method: Caregivers of children (mean age=6.53, SD=3.72, ages 1 to 17) with asthma were recruited from social media support groups and the Asthma UK charity research bulletin. Participants completed self report measures of mentalizing, family functioning, mood and anxiety difficulties. Results: A total of 88 caregivers completed the full survey. Results indicated that poorer mentalizing capacity was significantly associated with poorer family functioning and increased mood and anxiety symptomatology. Poor mentalizing was significantly associated with increased levels of depression, hypomania and anxiety, explaining 16% of variance in depression and 10% of variance in anxiety. Family functioning was not a significant predictor after controlling for the effect of mentalizing. Conclusions: These findings suggest that mentalizing capacity might be a valued new treatment target to improve the mental health of caregivers of children with asthma. The results suggest that mentalizing could complement previously identified factors such as family functioning or asthma symptom severity in understanding caregivers’ mental health. Further investigation into the role of mentalizing in the mental health of this population is warranted.

Objectives: This study characterizes risk-taking behaviours in a group of people with a self-reported diagnosis of BD using fuzzy trace theory (FTT). FTT hypothesizes that risk-taking is a ‘reasoned’ (but sometimes faulty) action, rather than an impulsive act associated with mood fluctuations. Design: We tested whether measures of FTT (verbatim and gist-based thinking) were predictive of risk-taking intentions in BD, after controlling for mood and impulsivity. We hypothesized that FTT scales would be significant predictors of risk-taking intentions even after accounting for mood and impulsivity. Methods: Fifty-eight participants with BD (age range 21–78, 68% female) completed a series of online questionnaires assessing risk intentions, mood, impulsivity, and FTT. Results: Fuzzy trace theory scales significantly predicted risk-taking intentions (medium effect sizes), after controlling for mood and impulsivity consistent with FTT (part range.26 to.49). Participants with BD did not show any statistically significant tendency towards verbatim-based thinking. Conclusions: Fuzzy trace theory gist and verbatim representations were both independent predictors of risk-taking intentions, even after controlling for mood and impulsivity. The results offer an innovative conceptualization of the mechanisms behind risk-taking in BD. Practitioner points: Risk-taking behaviour in bipolar disorder is not just a consequence of impulsivity. Measures of fuzzy trace theory help to understand risk-taking in bipolar disorder. FTT measures predict risk-taking intentions, after controlling for mood and impulsivity.

This thesis comprises a systematic literature review, an empirical paper and a critical appraisal. A systematic review of quantitative studies examining the efficacy of cognitive interventions to improve decision-making in people with Mild Cognitive Impairment (MIC) was conducted. Twenty-six papers were identified. Results indicate that interventions to improve decision-making in people with MCI can be effective. Most studies tested interventions designed to improve higher-order thinking skills, or executive functions, that are thought to underpin decision-making. Of these, interventions targeting logical reasoning, cognitive control and inhibition demonstrated the best results. Risk of bias arising from poor quality research design or reporting affected most studies. Consequently, it was not possible to draw clear conclusions about the efficacy of particular interventions at this time. Implications and recommendations for research are discussed. The empirical paper explores the feasibility of using a capacity assessment tool designed to support remote working during the COVID-19 health crisis. Views were gathered from eight participants either through online focus groups or online individual interviews. Data from transcribed discussions, notes taken by a focus group assistant and notes from focus group debrief sessions between the researcher and focus group assistant were analysed using thematic analysis. Findings indicate that the tool is perceived to be feasible for use in practice and merits additional research. The assessment tool was praised for its structure and for prompts, questions and examples that enabled participants to obtain useful data in a pressurised context. Clinical implications are discussed and recommendations for research are outlined. The critical appraisal section offers reflections on the process of undertaking research into mental capacity and decision making. Ethical, philosophical and practical benefits and challenges are explored. The e

Short Term Psychodynamic Psychotherapy (STPP) has been demonstrated as an effective treatment for several mental health difficulties. However, its implementation in secondary mental health services in the National Health Service (NHS) is scarce. The aim of this study was to bridge the gap between controlled trials and practice-based evidence, by exploring an initial estimate of the therapeutic effects of this intervention as well as its safety in a secondary care NHS community mental health setting. Method: The study followed a quantitative case series design. Eight clients with complex, enduring mental health difficulties, supported by a community secondary mental health service received a course of STPP. They completed outcome measures at the start, at the end and eight-weeks following completion of therapy. Results: All participants but one completed the therapy and attendance rates were high (>75%). No adverse effects were reported. All participants but two reported improvement in the CORE-OM, BSI and the PHQ-9 and these were maintained at follow-up. Conclusions: The results suggested that STPP was a safe and acceptable intervention, that may have contributed to clinical and reliable improvement for 4 participants, non-reliable improvement for 2 and non-reliable deterioration for one participant who finished the treatment.

The aim of this thesis was to explore the impact of the common sleep-related breathing disorder, obstructive sleep apnoea (OSA); specifically for people with a bipolar disorder (BD) diagnosis but also the wider experience of the first-line treatment for OSA, positive airway pressure (PAP). Chapter 1 is a systematic literature review and thematic synthesis of experiences using PAP to treat OSA. Twenty-five papers were reviewed and included in the thematic synthesis. The quality of each paper was appraised and considered in relation to contribution to the resultant analytical themes. The metasynthesis gave voice to user experiences of PAP and revealed barriers to PAP use at a healthcare service level. The findings highlight the need for a biopsychosocial approach and long-term person-centred support to enhance PAP use. Chapter 2 is a primary empirical research paper on an investigation as to whether people with suspected-OSA and a BD diagnosis experience more sleep and affect instability when “inter-episode” compared to people with a BD diagnosis alone. Ecological momentary assessment was utilised. Eighteen participants (twelve with suspected-OSA) wore an acitgraph for two weeks whilst completing an affect questionnaire twice daily. Measures of instability were calculated using the mean squared successive difference and probability of acute change indices. The groups were not found to significantly differ other than reduced sleep efficiency in the suspected-OSA group. However, only 48% of the intended sample was successfully recruited due to the COVID-19 pandemic. Important avenues for further research are highlighted. Chapter 3 is a critical appraisal of the thesis. Salient issues relevant to future research and clinical practice are discussed, in addition to the under recognised clinical issue of sleep which inspired this thesis.

Background Currently 22% of the UK population die in care homes, mostly within 18 months of admission, yet there is little research about the nature of symptoms at the end of life in this population. The limited evidence suggests that the dying trajectory may be different to other populations. Aim To describe the presence and intensity of physical symptoms of residents during the dying phase and explore common characteristics that occur over time. Methods This prospective cohort study used the Modified Edmonton Symptom Assessment Scale (ESAS) to collate demographic and symptom characteristics from 157 residents during the final days of life in 11 care homes. Descriptive statistics were used to present demographic and clinical characteristics. The presence and intensity of both symptom load and individual symptoms was tested for significance with either ANOVA or Cochran’s Q and post-hoc comparisons performed. Finally, an inferential analysis was performed to test for associations between presence and intensity and key characteristics. Results The five most common symptoms nearest to death were drowsiness, fatigue, anorexia, unable to respond and shortness of breath with a significant increase in both presence and intensity of these symptoms towards the time of death. Only a small number of associations between demographics, diagnoses and symptoms were observed. Discussion The main symptoms occurring in residents relate to a general deteriorative condition suggesting that dying in care homes is characterised by a gradual decline, with an increased presence and intensity of symptoms towards the time of death. Symptoms can be classified as ‘silent’ or ‘strident’, resulting in a typology that has not been previously identified in symptom research in this population. The limited associations between co-variables indicate that despite differences in age, gender, number of diagnoses and length of stay, this cohort is a homogenous group during the last few days of life. Conc

Background Advanced cancer affects people’s lives, often causing stress, anxiety and depression. Peer mentor interventions are used to address psychosocial concerns, but their outcomes and effect are not known. Our objective was to determine the feasibility of delivering and investigating a novel peer mentor intervention to promote and maintain psychological wellbeing in people with advanced cancer. Methods A mixed methods design incorporating a two-armed controlled trial (random allocation ratio 1:1) of a proactive peer mentor intervention plus usual care, vs. usual care alone, and a qualitative process evaluation. Peer mentors were recruited, trained, and matched with people with advanced cancer. Quantitative data assessed quality of life, coping styles, depression, social support and use of healthcare and other supports. Qualitative interviews probed experiences of the study and intervention. Results Peer mentor training and numbers (n = 12) met feasibility targets. Patient participants (n = 12, from 181 eligible who received an information pack) were not recruited to feasibility targets. Those who entered the study demonstrated that intervention delivery and data collection were feasible. Outcome data must be treated with extreme caution due to small numbers, but indicate that the intervention may have a positive effect on quality of life. Conclusions Peer mentor interventions are worthy of further study and researchers can learn from these feasibility data in planning participant recruitment and data collection strategies. Pragmatic trials, where the effectiveness of an intervention is tested in real-world routine practice, may be most appropriate. Peer mentor interventions may have merit in enabling survivors with advanced cancer cope with their disease.

BACKGROUND: Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. METHODS: A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. RESULTS: One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. CONCLUSION: Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.

Background People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. Objectives To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. Design The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. Setting Nursing homes in England providing care for people with dementia. Participants Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. Intervention Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. Main outcome measures The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data – health economic outcomes, medication/service use and intervention activity. Results Phase 1 (realist review; 86 papers) iden

Objectives: This study characterizes risk-taking behaviours in a group of people with a self-reported diagnosis of BD using fuzzy trace theory (FTT). FTT hypothesizes that risk-taking is a ‘reasoned’ (but sometimes faulty) action, rather than an impulsive act associated with mood fluctuations. Design: We tested whether measures of FTT (verbatim and gist-based thinking) were predictive of risk-taking intentions in BD, after controlling for mood and impulsivity. We hypothesized that FTT scales would be significant predictors of risk-taking intentions even after accounting for mood and impulsivity. Methods: Fifty-eight participants with BD (age range 21–78, 68% female) completed a series of online questionnaires assessing risk intentions, mood, impulsivity, and FTT. Results: Fuzzy trace theory scales significantly predicted risk-taking intentions (medium effect sizes), after controlling for mood and impulsivity consistent with FTT (part range.26 to.49). Participants with BD did not show any statistically significant tendency towards verbatim-based thinking. Conclusions: Fuzzy trace theory gist and verbatim representations were both independent predictors of risk-taking intentions, even after controlling for mood and impulsivity. The results offer an innovative conceptualization of the mechanisms behind risk-taking in BD. Practitioner points: Risk-taking behaviour in bipolar disorder is not just a consequence of impulsivity. Measures of fuzzy trace theory help to understand risk-taking in bipolar disorder. FTT measures predict risk-taking intentions, after controlling for mood and impulsivity.

In 2018, De Los Reyes and Langer expanded the scope of the Evidence Base Updates series to include reviews of psychological assessment techniques. In keeping with the goal of offering clear "take-home messages" about the evidence underlying the technique, experts have proposed a rubric for evaluating the reliability and validity support. Changes in the research environment and pressures in the peer review process, as well as a lack of familiarity with some statistical methods, have created a situation where many findings that appear “excellent” in the rubric are likely to be “too good to be true,” in the sense that they are unlikely to generalize to clinical settings or are unlikely to be reproduced in independent samples. We describe several common scenarios where published results are often too good to be true, including internal consistency, inter-rater reliability, correlation, standardized mean differences, diagnostic accuracy, and global model fit statistics. Simple practices could go a long way towards improving design, reporting, and interpretation of findings. When effect sizes are in the “excellent” range for issues that have been challenging, scrutinize before celebrating. When benchmarks are available base on theory or meta-analyses, results that are moderately better than expected in the favorable direction (i.e., Cohen’s q≥+.30) also invite critical appraisal and replication before application. If readers and reviewers pull for transparency and do not unduly penalize authors who provide it, then change in research quality will be faster and both generalizability and reproducibility are likely to benefit.

Purpose: This study reviewed the evidence base status of Mentalisation Based Treatment (MBT), its quality, strengths and limitations. The aim was to pave the way for further MBT research. Method: An electronic database and reference lists search identified MBT outcome papers and these were systematically reviewed. The quality of the studies and the risk of bias were determined using two validated checklist tools. Results: Twenty-three studies were included in the review. This included nine randomised controlled trials, seven uncontrolled pre-post effectiveness studies, three retrospective cohort studies, two uncontrolled randomised trials and two case studies. The methodological quality of almost half of the papers was assessed as fair (43%), followed by good (34%) poor (17%) and excellent (4%) ratings. Nevertheless, the review identified risk of confounding bias across the majority of studies (60%) and fidelity to treatment was poorly reported in almost half of the studies (47%). Most of the studies focused on Borderline Personality Disorder (BPD), showing positive clinical outcomes for this population but the evidence base for other presentations was still developing. The treatment of adolescents who self-harm and at-risk mothers in substance abuse treatment showed particularly promising results, as these are client groups that have previously shown limited positive response to psychological interventions. Conclusions: MBT is a potentially effective method across a wide range of clinical presentations but further research should focus on increasing the quality and the quantity of the MBT evidence outside the treatment of BPD.

Background: Some mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first study of this type. Methods: In a randomized controlled trial (RCT), 579 children ages 7-10 (M=8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent Class Analysis and Linear Mixed Effects Models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. Results: A 3-class solution demonstrated best fit for the NEO: MN&MC=moderate neuroticism and conscientiousness (n=284); HN&LC=high neuroticism, low conscientiousness (n=83); LN&HC=low neuroticism, high conscientiousness (n=70). Per parent-reported symptoms: children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; Children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Conclusions: Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid treatment selection for children with ADHD, though additional research on this topic is needed.

Bipolar Disorder (BD) is characterised by shifts between episodes of mania, hypomania and depression. BD is considered a lifelong diagnosis and individuals with BD are estimated to be symptomatic for almost half their life. Individuals with BD can have excessive involvement in activities that have a high potential for adverse consequences. Such activities include spending sprees, sexual indiscretions, shoplifting and aggression. The consequences of these actions can often have a severe impact on their social, educational, occupational and daily functioning. Section 1 is a qualitative systematic literature review that explored how self management strategies are perceived by individuals with BD. A meta-ethnography approach was used to synthesise 18 qualitative research studies. Three themes were identified; “The Process of Successful Self-Management Skills”, “Self-management: Symptom-management or Lifestyle-management” and “The Fear of a Relapse”. Implications of the findings suggest that self-management strategies should encourage individual adjustments so that the individual can adapt their behaviour in different contexts. It may also be helpful to change the focus on lifestyle rather than symptoms. Finally, an underlying fear may be impacting the adherence to self-management strategies. Section 2 is a qualitative research study that explored how individuals with BD consider risk in everyday decisions. Eight participants were interviewed. Interpretative phenomenological analysis was used to analyse the interviews. Four themes were identified that impacted an individual’s consideration of risk: identity, control, fear and supporting network. Implications include individual explorations of how the four themes may be impacting on the risk-taking decision-making process. Section 3 is a reflexive critical appraisal of the thesis process. It gives a summary of the two papers before reflexively discussing three topics that involved key decisions and learning points.

In 2018, De Los Reyes and Langer expanded the scope of the Evidence Base Updates series to include reviews of psychological assessment techniques. In keeping with the goal of offering clear "take-home messages" about the evidence underlying the technique, experts have proposed a rubric for evaluating the reliability and validity support. Changes in the research environment and pressures in the peer review process, as well as a lack of familiarity with some statistical methods, have created a situation where many findings that appear “excellent” in the rubric are likely to be “too good to be true,” in the sense that they are unlikely to generalize to clinical settings or are unlikely to be reproduced in independent samples. We describe several common scenarios where published results are often too good to be true, including internal consistency, inter-rater reliability, correlation, standardized mean differences, diagnostic accuracy, and global model fit statistics. Simple practices could go a long way towards improving design, reporting, and interpretation of findings. When effect sizes are in the “excellent” range for issues that have been challenging, scrutinize before celebrating. When benchmarks are available base on theory or meta-analyses, results that are moderately better than expected in the favorable direction (i.e., Cohen’s q≥+.30) also invite critical appraisal and replication before application. If readers and reviewers pull for transparency and do not unduly penalize authors who provide it, then change in research quality will be faster and both generalizability and reproducibility are likely to benefit.

Purpose: This study reviewed the evidence base status of Mentalisation Based Treatment (MBT), its quality, strengths and limitations. The aim was to pave the way for further MBT research. Method: An electronic database and reference lists search identified MBT outcome papers and these were systematically reviewed. The quality of the studies and the risk of bias were determined using two validated checklist tools. Results: Twenty-three studies were included in the review. This included nine randomised controlled trials, seven uncontrolled pre-post effectiveness studies, three retrospective cohort studies, two uncontrolled randomised trials and two case studies. The methodological quality of almost half of the papers was assessed as fair (43%), followed by good (34%) poor (17%) and excellent (4%) ratings. Nevertheless, the review identified risk of confounding bias across the majority of studies (60%) and fidelity to treatment was poorly reported in almost half of the studies (47%). Most of the studies focused on Borderline Personality Disorder (BPD), showing positive clinical outcomes for this population but the evidence base for other presentations was still developing. The treatment of adolescents who self-harm and at-risk mothers in substance abuse treatment showed particularly promising results, as these are client groups that have previously shown limited positive response to psychological interventions. Conclusions: MBT is a potentially effective method across a wide range of clinical presentations but further research should focus on increasing the quality and the quantity of the MBT evidence outside the treatment of BPD.