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Doctoral Researchers (DRs) are an important part of the academic community and, after graduating, make substantial social and economic contributions. Despite this importance, DR wellbeing has long been of concern. Recent studies have concluded that DRs may be particularly vulnerable to mental health problems, yet direct comparisons of the prevalence of mental health problems between this population and control groups are lacking. Here, by comparing DRs with educated working controls, we show that DRs report significantly greater anxiety and depression, and that this difference is not explained by a higher rate of pre-existing mental health problems. Moreover, most DRs perceive poor mental health as a ‘normal’ part of the PhD process. Thus, our findings suggest a hazardous impact of PhD study on mental health, with DRs being particularly at risk of developing common mental health problems. This provides an evidence-based mandate for universities and funders to reflect upon practices related to DR training and mental health. Our attention should now be directed towards understanding what factors may explain heightened anxiety and depression among DRs so as to inform preventative measures and interventions.

BackgroundHealthcare workers (HCWs) treating and caring for patients with emerging infectious diseases often experience psychological distress. However, the psychological impact and behavior change of the coronavirus disease 2019 (COVID-19) pandemic among HCWs are still unknown. This study aimed to investigate the worries and concerns of HCWs regarding the COVID-19 pandemic.MethodsIn this cross-sectional survey, a web-based questionnaire was distributed among HCWs working in hospitals or clinics across Japanese medical facilities from April 20 to May 1, 2020. The questionnaire comprised items on demographics, worries and concerns, perceptions regarding the sufficiency of information, and behavioral changes pertaining to the COVID-19 pandemic.ResultsA total of 4386 HCWs completed the survey; 1648 (64.7%) were aged 30-39 years, 2379 (54.2%) were male, and 782 (18.1%) were frontline HCWs, directly caring for patients with COVID-19 on a daily basis. 3500 HCWs (79.8%) indicated that they were seriously worried about the pandemic. The most frequent concern was the consequence of becoming infected on their family, work, and society (87.4%). Additionally, the majority (55.5%) had restricted social contact and almost all HCWs endorsed a shortage in personal protective equipment (median, 8/9 (interquartile range; 7-9) on a Likert scale). There was no significant difference in the degree of worry between frontline and non-frontline HCWs (8/9 (7-9) vs. 8/9 (7-9), p=0.25). Frontline HCWs, compared to non-frontline HCWs, were more likely to have the need to avoid contact with families and friends (24.8% vs. 17.8%, pConclusionsBoth frontline and non-frontline HCWs expressed comparable concerns regarding the COVID-19 pandemic. Because HCWs, especially frontline HCWs, reported that they cannot be obliged to do avoid their duty, effective mental health protection strategies should be developed and implemented for HCWs.

The recent COVID-19 pandemic led to uncertainty and severe health and economic concerns. Previous studies indicated that owning a companion animal, such as a dog or a cat, has benefits for good mental health. Interactions with animals may help with depression and anxiety, particularly under stress-prone conditions. Human–animal interactions may even improve peer-to-peer social relationships, as well as enhance feelings of respect, trust, and empathy between people. Interestingly, it has also been shown that stress and poor well-being of dog owners negatively affect the well-being of their companion animals. However, a dramatic increase in dog abandonment could potentially occur due to COVID-19 related health, economic and social stresses, as well as due to the inconclusive reports of companion animals being potential COVID-19 carriers. Such a scenario may lead to high costs and considerable public health risks. Accordingly, we hypothesized that the COVID-19 pandemic, and the related social isolation, might lead to dramatic changes in human–dog bidirectional relationships. Using unique prospective and retrospective datasets, our objectives were to investigate how people perceived and acted during the COVID-19 pandemic social isolation, in regards to dog adoption and abandonment; and to examine the bidirectional relationship between the well-being of dog owners and that of their dogs. Overall, according to our analysis, as the social isolation became more stringent during the pandemic, the interest in dog adoption and the adoption rate increased significantly, while abandonment did not change. Moreover, there was a clear association between an individual’s impaired quality of life and their perceptions of a parallel deterioration in the quality of life of their dogs and reports of new behavioral problems. As humans and dogs are both social animals, these findings suggest potential benefits of the human–dog relationships during the COVID-19 pandemic, in accordance with the One Welfare approach that implies that there is a bidirectional connection between the welfare and health of humans and non-human animals. As our climate continues to change, more disasters including pandemics will likely occur, highlighting the importance of research into crisis-driven changes in human–animal relationships.

Wetland parks are designed to support urban ecological protection, flood control and human well-being. Existing research mainly focuses on their influence on ecology and economy. However, their influence on human well-being and health is rarely studied. In China, during the peak of the COVID-19 pandemic (Peak), people were very concerned about health, while at the same time wetland parks which are generally considered beneficial to health were closed. Thus, this study explores the public’s perception of the health effects of visiting wetland parks and the impact of the pandemic on the perception. From March 5th to 8th, 2020, before the Peak in China was over, 1,400 respondents participated in a nationwide online survey. It was found that the perceived benefits from visiting wetland parks were higher in terms of mental health than in physical health. Also, the perceived health benefits of wetland parks after the Peak were slightly higher than before the pandemic. The results highlight that wildlife habitat services were considered to be the most important ecosystem services that promote the perceived health benefits. Interestingly, the perceived health benefits of wetland parks by health experts appear to be lower than in other groups, indicating that the health benefits of visiting wetland parks may be overestimated by lay-people or underestimated by health experts. The results provide empirical evidence for managing ecosystem services as delivered by these urban wetlands, in the context of COVID-19 or potential future pandemics, for promoting public health.

The COVID-19 pandemic has introduced a myriad of challenges to the social life and care of people with Parkinson’s disease (PD), which could potentially worsen mental health problems. We used baseline data of the PRIME-NL study (N = 844) to examine whether the association between COVID-19 stressors and mental health is disproportionately large in specific subgroups of people with PD and to explore effects of hypothetical reductions in COVID-19 stressors on mental health and quality of life. The mean (SD) age of the study population was 70.3 (7.8) years and 321 (38.0%) were women. The linear regression effect estimate of the association of COVID-19 stressors with mental health was most pronounced in women, highly educated people, people with advanced PD and people prone to distancing or seeking social support. Smaller effect estimates were found in people scoring high on confrontive coping or planful problem solving. The parametric G-formula method was used to calculate the effects of hypothetical interventions on COVID-19 stressors. An intervention reducing stressors with 50% in people with above median MDS-UPDRS-II decreased the Beck Depression Inventory in this group from 14.7 to 10.6, the State-Trait Anxiety Inventory from 81.6 to 73.1 and the Parkinson’s Disease Quality of Life Questionnaire from 35.0 to 24.3. Insights from this cross-sectional study help to inform tailored care interventions to subgroups of people with PD most vulnerable to the impact of COVID-19 on mental health and quality of life.

Exercise addiction (EA) involves excessive concerns for exercise routines, an abusive practice, and the inability to control one’s own behavior, as well as the presence of psychological processes that are typical of behavioral addictions such as abstinence. EA is further associated with an alteration of the individual’s personal, social, and professional functioning and a higher risk for several pathologies, including physical injury, psychological distress, and eating disorders. The present work presents a narrative scoping review of the state of the art and the main findings of the research on EA, with a focus in the athletic population. The prevalence of EA risk, between 1 and 52% and up to 80% when co-occurring with eating disturbances, is also reviewed. Additionally, some of the explanatory models proposed to date and their power and limitations in terms of their capacity for a consensual operationalization and characterization of EA, and thus for the optimal exploration and management of this condition, are discussed. Finally, some deficiencies in the research on EA are noted which are to be addressed to successfully respond to the intervention and prevention needs that occur both in the general context of exercise-sports practice and the specific context of competitive athletes., CRUE-CSIC, Research Group CTS267 by Junta de Andalucía (Spain), Universidad de Granada/CBUA

Eveningness, a preference for later sleep and rise times, has been associated with a number of negative outcomes in terms of both physical and mental health. A large body of evidence links eveningness to Major Depressive Disorder (MDD). However, to date, evidence quantifying this association is limited. The current meta-analysis included 43 effect sizes from a total 27,996 participants. Using a random-effects model it was demonstrated that eveningness is associated with a small effect size (Fisher’s Z = − 2.4, 95% CI [− 0.27. − 0.21], p

This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig = .019, ηp2 = .258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig = .031, ηp2 = .146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings.

Abstract Having access to parenting interventions in the early years is key to improve the developmental outcomes of children with neurodevelopmental problems. The Incredible Years® (IY) Parent Program is a group intervention that has demonstrated efficacy in terms of reducing stress in parents, as well as improving behavioral, emotional, and social outcomes in children. The program has been recently adapted for families of children with autism or language delays (IY-ASLD®). This intervention has not yet been implemented in the Spanish Public Health System, where there is a scarcity of evidence-based interventions being offered to families with young children presenting neurodevelopmental problems. The main aims of this study are to determine the feasibility of implementing the IY-ASLD® program within Spanish Child Mental Health Services and to examine parents’ acceptability and satisfaction with the intervention. As a secondary objective, we aim to evaluate its preliminary effectiveness in terms of reducing parental stress and behavioral difficulties in their children. The FIRST STEPS study is a multicenter, pilot randomized controlled trial comparing the IY-ASLD® program with a treatment-as-usual (TAU) condition. Approximately 70 families of children with autism spectrum disorder (ASD) and preterm children with communication and/or socialization difficulties (aged 2–5 years) will be recruited. Families will be assessed prior to randomization and after the intervention. Due to the COVID-19 pandemic, the intervention will consist of 22 weekly online sessions (approximately 6 months). The FIRST STEPS pilot trial will demonstrate the feasibility and acceptability of reliably implementing the IY-ASLD® program within the Spanish Public Health System. The results of this study could represent the first step to inform policymakers in Spain when designing evidence-based healthcare pathways for families of children presenting ASD symptoms or neurodevelopmental difficulties at early stages. Trial registration ClinicalTrials.gov NCT04358484. Registered on 04 April 2020

Subtle alterations in white matter microstructure are observed in youth at clinical high risk (CHR) for psychosis. However, the timing of these changes and their relationships to the emergence of psychosis remain unclear. Here, we track the evolution of white matter abnormalities in a large, longitudinal cohort of CHR individuals comprising the North American Prodrome Longitudinal Study (NAPLS-3). Multi-shell diffusion magnetic resonance imaging data were collected across multiple timepoints (1���5 over 1 year) in 286 subjects (aged 12���32 years): 25 CHR individuals who transitioned to psychosis (CHR-P; 61 scans), 205 CHR subjects with unknown transition outcome after the 1-year follow-up period (CHR-U; 596 scans), and 56 healthy controls (195 scans). Linear mixed effects models were fitted to infer the impact of age and illness-onset on variation in the fractional anisotropy of cellular tissue (FAT) and the volume fraction of extracellular free water (FW). Baseline measures of white matter microstructure did not differentiate between HC, CHR-U and CHR-P individuals. However, age trajectories differed between the three groups in line with a developmental effect: CHR-P and CHR-U groups displayed higher FAT in adolescence, and 4% lower FAT by 30 years of age compared to controls. Furthermore, older CHR-P subjects (20+ years) displayed 4% higher FW in the forceps major (p < 0.05). Prospective analysis in CHR-P did not reveal a significant impact of illness onset on regional FAT or FW, suggesting that transition to psychosis is not marked by dramatic change in white matter microstructure. Instead, clinical high risk for psychosis���regardless of transition outcome���is characterized by subtle age-related white matter changes that occur in tandem with development.

Social isolation is a growing public health concern for older adults, as it has been associated with poor health and premature mortality. On the other hand, physical inactivity and an inadequate diet are important health risk behaviours associated with physical and mental health problems. Considering that there is no research examining the possible relationship between social isolation and the above mentioned health risk behaviours of European middle-aged and older adults, this cross-sectional study aims to contribute to filling this gap., Fundação Calouste Gulbenkian

This version of the article has been accepted for publication, after peer review and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at https://doi.org/10.1007/s00127-021-02143-4. Purpose - The purpose of this study is to assess whether violence exposure is associated with emotional/conduct problems, when adjusting for confounders/covariates and controlling for comorbidity, and to investigate interactions between violence exposure and sex and/or age. Methods - This cross-sectional study evaluated a community-based sample of 669 in-school 11–15-year-olds. A three-stage probabilistic sampling plan included a random selection of census units, eligible households, and target child. Multivariable logistic regression investigated the effect of severe physical punishment by parents, peer victimization at school, and community violence on the study outcomes (adolescent-reported emotional/conduct problems identified by the Strengths and Difficulties Questionnaire/SDQ) when controlling for confounders (resilience, parental emotional warmth, maternal education/unemployment/anxiety/depression) and covariates (age, sex, stressful life events, parental rejection). Results - Considering interactions, emotional problems were associated with community violence victimization among girls, while conduct problems were associated with severe physical punishment among the younger, suffering peer aggression among the oldest, bullying victimization among girls, and witnessing community violence among boys. Desensitization (less emotional problems with greater violence exposure) was noted among the youngest exposed to severe physical punishment and the oldest who witnessed community violence. Conclusion - Age and sex are moderators of the association between violence exposure and emotional/conduct problems. Interventions at local health units, schools, and communities could reduce the use of harsh physical punishment as a parental educational method, help adolescents deal with peer aggression at school and keep them out of the streets by increasing the usual five hours in school per day and making free sports and cultural/leisure activities available near their homes.

Type 2 diabetes mellitus (T2D) is often accompanied by chronic diseases, including mental health problems. We aimed at studying mental health comorbidity prevalence in T2D patients and its association with T2D outcomes through a retrospective, observational study of individuals of the EpiChron Cohort (Aragón, Spain) with prevalent T2D in 2011 (n = 63,365). Participants were categorized as having or not mental health comorbidity (i.e., depression, anxiety, schizophrenia, and/or substance use disorder). We performed logistic regression models, controlled for age, sex and comorbidities, to analyse the likelihood of 4-year mortality, 1-year all-cause hospitalization, T2D-hospitalization, and emergency room visit. Mental health comorbidity was observed in 19% of patients. Depression was the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was higher in patients with mental health comorbidity (odds ratio 1.24; 95% confidence interval 1.16-1.31), especially in those with substance use disorder (2.18; 1.84-2.57) and schizophrenia (1.82; 1.50-2.21). Mental health comorbidity also increased the likelihood of all-cause hospitalization (1.16; 1.10-1.23), T2D-hospitalization (1.51; 1.18-1.93) and emergency room visit (1.26; 1.21-1.32). These results suggest that T2D healthcare management should include specific strategies for the early detection and treatment of mental health problems to reduce its impact on health outcomes. This work was supported by Gobierno de Aragón [B01_20R] and the European Regional Development Fund “Construyendo Europa desde Aragón”. The authors sincerely thank Eva Giménez Labrador for her statistical support. Sí

The aim of this study was to investigate the experiences of parents in providing support to their child following trauma exposure in cases where children are experiencing clinically significant levels of post-traumatic distress. Qualitative interviews were conducted with parents whose child was exposed to a trauma and referred for psychological treatment. Parents reported considerable anxiety in coping with their child’s post-traumatic distress. Avoidance of trauma-related discussions was encouraged due to concerns that non-avoidant approaches may worsen children’s post-trauma difficulties. Nonetheless, parents were often sensitive to their child’s distress and offered reassurance and other forms of support. Many barriers existed to accessing psychological treatment, and perceptions of inadequate guidance from therapists on supporting child adjustment contributed to parental distress. The results illustrate the strategies used by parents in supporting their child post-trauma and may assist mental health professionals in providing acceptable guidance to parents following child trauma.

PurposeCurrent RCT and meta-analyses have not found any effect of community treatment orders (CTOs) on hospital or social outcomes. Assumed positive impacts of CTOs on quality-of-life outcomes and reduced hospital costs are potentially in conflict with patient autonomy. Therefore, an analysis of the cost and quality-of-life consequences of CTOs was conducted within the OCTET trial.MethodsThe economic evaluation was carried out comparing patients (n = 328) with psychosis discharged from involuntary hospitalisation either to treatment under a CTO (CTO group) or voluntary status via Section 17 leave (non-CTO group) from the health and social care and broader societal perspectives (including cost implication of informal family care and legal procedures). Differences in costs and outcomes defined as quality-adjusted life years (QALYs) based on the EQ-5D-3L or capability-weighted life years (CWLYs) based on the OxCAP-MH were assessed over 12 months (£, 2012/13 tariffs).ResultsMean total costs from the health and social care perspective [CTO: £35,595 (SD: £44,886); non-CTO: £36,003 (SD: £41,406)] were not statistically significantly different in any of the analyses or cost categories. Mental health hospitalisation costs contributed to more than 85% of annual health and social care costs. Informal care costs were significantly higher in the CTO group, in which there were also significantly more manager hearings and tribunals. No difference in health-related quality of life or capability wellbeing was found between the groups.ConclusionCTOs are unlikely to be cost-effective. No evidence supports the hypothesis that CTOs decrease hospitalisation costs or improve quality of life. Future decisions should consider impacts outside the healthcare sector such as higher informal care costs and legal procedure burden of CTOs.

This study examined inpatient rehabilitations service in one area in England following a programme of planned bed closures in parts of the service. The study examined changes to admission rates and length of stay in the parts of the service that existed prior to and after the bed closure programme. A mixed method evaluation design was used. Quantitative data relating to admissions and length of inpatients stays bed days was compared for the 3 years up to the bed closures and for the 3 years afterwards. Similarly use of mental health sections for service users being admitted, and contacts with community mental health teams were also compared for the same 3-year pre and post period. Qualitative data from service users, carers of service users, and staff were analyzed thematically to provide an insight into any changes in rehabilitation service usage as a result of the closure programme. In the rehabilitation services that existed before and after bed closures in other parts of the service quantitative findings showed a significant reduction post-rehabilitation stay in all measures except contact with community teams. Qualitative analysis revealed that this is because rehabilitation enables a successful transition into the community and allows for effective relationships to be built between staff and service user. The reduction seen in service utilization suggests rehabilitation has the potential to reduce the revolving door to inpatient metal health care.

STUDY DESIGN Psychometric study. OBJECTIVE The aim of the study was to translate and culturally adapt the MSISQ-15 into Italian and to administer it to individuals with a spinal cord injury (SCI). SETTING Rome's Wheelchair Rugby Team and three spinal units in Italy. METHODS Translation and validation of the MSISQ-15 were performed based on international guidelines. The questionnaire, which was in a paper and online format, was administered with the Short Form-12 Health Survey (SF-12) and the Spinal Cord Independence Measure Self-Report. RESULTS Sixty-five participants were recruited. Internal consistency coefficient of MSISQ-15 scale, assessed by Cronbach's alpha, was 0.75. Test-retest reliability interclass correlations was, for example, 0.86. The construct validity was calculated and showed statistically significant results in relation to the mental health status investigated with the SF-12. CONCLUSIONS The MSISQ-15 is a valid, reliable, and useful questionnaire for investigating how often the symptoms of an SCI interfere with a person's satisfaction or sexual activity.

Identifying oneself as overweight is a risk factor for poor mental health and suicidality independent from objective weight status. The stigma associated with heavier body weight has risen in recent decades and this may have exacerbated the detrimental mental health effects of perceived overweight. In this study, we examined the association between perceived overweight and suicidality in a nationally representative sample (N = 115,180) of US adolescents assessed from 1999 to 2017. We drew on data from the Youth Risk Behavior survey, a biennial population-based survey of students in grades 9–12. Suicidality was gauged by participant reports of past-year suicidal ideation, suicide plans, or suicide attempts. Across all waves, perceived overweight (vs. perceived “normal” weight) predicted a 7.7 percentage point (p

Psychological distress and alcohol abuse have been linked to intimate partner violence (IPV). However, not all victims develop these problems. This study analyses the impact of IPV severity, social support, and self-esteem on depressive and anxiety symptoms as well as on alcohol abuse, and tests social and personal resources as moderators of the abuse-psychological distress-substance abuse link in a sample of Portuguese women including victims and non-victims of IPV (N = 209). IPV severity contributed significantly to depression and anxiety symptoms as well as to alcohol abuse, after controlling for socio-demographic factors. Both social support and self-esteem were found to moderate the relation between IPV and depression and anxiety symptoms. However, moderation did not occur for the association between IPV and alcohol abuse. This study shows the impact of IPV on mental health and on alcohol abuse, and highlights the need to design effective interventions that promote social and personal resources in victimized women.

Background Genocide is an atrocity that seeks to destroy whole populations, leaving empty countries, empty spaces and empty memories, but also a large health burden among survivors is enormous. We propose a genocide reporting checklist to encourage consistent high quality in studies designed to provide robust and reliable data on the long term impact of genocide. Methods An interdisciplinary (Public Health, epidemiology, psychiatry, medicine, sociology, genocide studies) and international working committee of experts from Germany, Israel, the United States, and the United Kingdom used an iterative consensus process to develop a genocide studies checklist for studies of the long term health consequences. Results We created a list of eight domains (A Ethical approval, B External validity, C Misclassification, D Study design, E Confounder, F Data collection, G Withdrawal) with 1–3 specific items (total 17). Conclusion The genocide studies checklist is easy to use for authors, journal editors, peer reviewers, and others involved in documenting the health consequences of genocide. Electronic supplementary material The online version of this article (10.1186/s13031-019-0198-9) contains supplementary material, which is available to authorized users.

Background Evidence on patient-reported outcomes of newly diagnosed HIV patients is scarce, and largely cross-sectional. This prospective cohort study describes the prevalence of, and changes in, patient-reported outcomes in the three months after HIV diagnosis, in 11 HIV outpatient centres in Kenya and Uganda. Methods Adults were recruited within 14 days of result, completing self-report measures four times at monthly intervals. Multilevel mixed-effects linear regression (quality of life continuous outcomes) and ordinal logistic regression (symptoms and concerns categorical outcomes) modelled change over time, with repeated observations grouped within individuals adjusted for demographic/clinical characteristics, and multiple imputation for missing data. Results 438 adults were enrolled and 234 (53·4%) initiated ART. Improvement was found for MOS-HIV physical health (from 46·3 [95% CI 45·1–47·3], to 53·7 [95% CI 52.8–54·6], p

Background: Mental health disorders among adolescents have emerged as a major public health issue in many low and middle-income countries, including India. There is a paucity of research on the determinants of psychological distress, particularly among the poorest girls in the poorest communities. The purpose of this study was to assess the prevalence and correlates of different indicators of psychological distress among 13–14 year old low caste girls in rural, south India. Methods: Cross-sectional survey of 1191 low caste girls in two districts in north Karnataka, conducted as part of a cluster randomised-control trial. Bivariate and multivariate logistic regression analysis assessed correlates of different indicators of psychological distress. Results: More than one third of girls (35.1%) reported having no hope for the future. 6.9% reported feeling down, depressed or hopeless in the past 2 weeks. 2.1% reported thinking they would be better off dead or of hurting themselves in some way in the past 2 weeks. 1.6% reported sexual abuse, 8.0% rrecent eve teasing and 6.3% having no parental emotional support. Suicidal ideation was independently associated with sexual abuse (AOR 11.9 (3.0–47.0)) and a lack of parental emotional support (AOR 0.2 (0.1–0.5)). Feeling down, depressed or hopeless was independently associated with recent eve-teasing (AOR 2.9 (1.6–5.4)), a harassing or abusive school environment (AOR 3.9 (1.8–8.2)), being frequently absent (AOR 2.8 (1.5–5.5)) or having dropped out of school (AOR 2.1 (1.0–4.3)), and living in Vijayapura district (AOR 2.5 (1.6–4.1)). Having no hope for the future was independently associated with a range of factors, including recent “eve-teasing” (AOR 1.5 (1.0–2.4)), being engaged (AOR 2.9 (0.9–9.7)), not participating in groups (AOR 0.5 (0.4–0.6)) and a lack of emotional support (AOR 0.6 (0.4–0.7)). Conclusions: Rather than being a time of optimism, a third of low caste girls in rural north, Karnataka have limited hope for the future, with some contemplating suicide. As well as having important development benefits, interventions that address the upstream structural and gender-norms based determinants of poor mental health, and provide adolescent services for girls who require treatment and support, should have important benefits for girls’ psychological wellbeing. Trial registration: Prospectively registered at ClinicalTrials.GovNCT01996241 . November 27, 2013

Internationally, best practice in child abuse prevention is grounded in a public health approach – identifying risk factors (such as parental substance misuse, mental health problems, or family violence), and putting in place wide-reaching strategies to reduce the ‘burden of disease’ by altering the risk profile of the entire population (not just sub-groups identified as ‘at risk’). Families can play a crucial role in protecting children by providing a safe and supportive environment. Although family life and parenting activities are often framed as ‘private’ and ‘sacred’, and there is reluctance to tell parents what they should do (or for parents to seek help to improve their parenting capacity), there is considerable evidence that providing evidence-based supports at a population level can achieve significant benefits in reducing the likelihood of child maltreatment, while also enhancing the well-being of the greatest number of children. The greatest investment should be in primary prevention services, as they reach the largest number of families. If successfully implemented, primary prevention services will shift the “risk profile” positively for the entire population, which translates to fewer children and families in need of more intensive secondary or tertiary services. Policies that improve family access to services and supports that reduce stressors related to poverty, addiction and ill health will assist with prevention of child maltreatment. The broader availability of such whole-of-population strategies also helps with early identification of families ‘at risk’ or in need of additional supports. However, if strategies are only targeted to the most vulnerable families, the vast majority of parents experiencing difficulties with parenting will be ignored and it will be very difficult to impact on the prevalence of child maltreatment. Success should be measured by the engagement of universal service delivery platforms (which most children and their families encounter) in the task of protecting all children.

Background Strengthening routine information systems for mental health can augment scale up of community mental health services in India and other low- and middle-income countries. Currently little routine data is available in Indian settings. This study aimed to develop a core set of indicators for monitoring mental health care in primary health care settings Methods By using a sequential exploratory mixed methods design, key mental health indicators measuring service delivery and system performance were developed for the context of Madhya Pradesh, India. The research design involved a situation analysis, and conducting a prioritisation exercise and consultation workshops with key stakeholders. Results This study resulted in nine key mental health indicators covering both mental health service delivery indicators and mental health system indicators for Sehore district of Madhya Pradesh. Mean indicator priority scores ranging from 4.48 to 3.78 were reported. Conclusions This study demonstrated a phased approach to strengthen routine information systems for mental health at a primary care level in India. We recommend that similar research methods can be applied across comparable settings and these indicators can be adopted as a part of national routine information systems.

Background\ud Mental health is increasingly finding a place on global health and international development agendas. Advocates for Global Mental Health (GMH), and international organizations such as the World Health Organization (WHO) and the World Bank, argue that treatments available in high-income countries should also be made available in low- and middle-income countries. Such arguments are often made by comparing mental health to infectious diseases, including the relative disease and economic burdens they impose, and pointing to the applicability of the right to access treatment for mental health, not only infectious diseases. HIV/AIDS advocacy in particular has been held up by GMH advocates as offering an appropriate strategy for generating global commitment.\ud \ud Discussion\ud There is a need to assess how health issues are framed not only in relation to social goods outside of health (such as human rights, security or development), but also in relation to other health or disease models, and how health policy and practice is shaped as a result. The article debates the merits and consequences of likening mental health to HIV/AIDS, and identifies four major problems with the model for GMH advocacy being developed through these analogies: 1. An inappropriately universalizing global approach to context-specific problems; 2. A conception of human rights that focuses on the right to access treatment at the expense of the right to refuse it; 3. A tendency to treat poverty as a psychiatric issue, rather than recognizing that mental distress can be the result of poverty and other forms of inequality; 4. The prioritization of destigmatization of disease over social justice models.\ud \ud Conclusion\ud There are significant problems with the wholesale adoption of an (often simplified) version of HIV/AIDS advocacy as a model for GMH. Yet critical engagement with the important and nuanced differences between HIV/AIDS and mental health may nevertheless point to some possibilities for productive engagement and cross-fertilisation between advocates, activists and scholars in both fields.

Background Aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD), its associated correlates and relations with clinical and behavioural problems among children and adolescents with HIV/AIDS (CA-HIV) attending five HIV clinics in central and South Western Uganda. Methods This study used a quantitative design that involved a random sample of 1339 children and adolescents with HIV and their caregivers. The Participants completed an extensive battery of measures including a standardized DSM-5 referenced rating scale, the parent version (5–18 years) of the Child and Adolescent Symptom Inventory-5 (CASI-5). Using logistic regression, we estimated the prevalence of ADHD and presentations, correlates and its impact on negative clinical and behavioural factors. Results The overall prevalence of ADHD was 6% (n = 81; 95%CI, 4.8–7.5%). The predominantly inattentive presentation was the most common (3.7%) whereas the combined presentation was the least prevalent (0.7%). Several correlates were associated with ADHD: socio-demographic (age, sex and socio-economic status); caregiver (caregiver psychological distress and marginally, caregiver educational attainment); child’s psychosocial environment (quality of child-caregiver relationship, history of physical abuse and marginally, orphanhood); and HIV illness parameters (marginally, CD4 counts). ADHD was associated with poor academic performance, school disciplinary problems and early onset of sexual intercourse. Conclusions ADHD impacts the lives of many CA-HIV and is associated with poorer academic performance and earlier onset of sexual intercourse. There is an urgent need to integrate the delivery of mental health services into routine clinical care for CA-HIV in Sub-Saharan Africa. Electronic supplementary material The online version of this article (10.1186/s12888-017-1488-7) contains supplementary material, which is available to authorized users.

Background Except for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients’ overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer. Methods Based on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006–2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events. Results Among 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18–29 days (HR 0.86; 95% CI 0.74-1.00) and 30–60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9–17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications. Conclusions These data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric vulnerabilities. Our study sheds further light on the complexity of waiting time management, and calls for a comprehensive strategy that takes into account different domains of patient well-being in addition to the overall survival., This study was partly supported by the Swedish Cancer Society (grant No: CAN 2014/417).

Background Patient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants. Methods This is a cluster trial, embedded within a host trial (‘EQUIP’) recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation. Results Thirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes. Conclusion To our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research. Trial registration numbers ISRCTN, ISRCTN16488358. Registered on 14 May 2014. Study Within A Trial, SWAT-26. Registered on 21 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1718-1) contains supplementary material, which is available to authorized users.

BackgroundEpidemiological studies have implicated Asian sand dust (ASD) in the increased prevalence of respiratory disorders, including asthma. It has been observed that fungal elements such as β-glucan can be adsorbed onto ASD. In the present study, the exacerbating effect of the combined exposure to zymosan A (ZymA) containing yeast β-glucan and heat-inactivated ASD on ovalbumin (OVA)-induced murine lung eosinophilia was investigated.MethodsBALB/c mice were repeatedly instilled intratracheally with one of eight immunogenic formulations consisting of various combinations of (1) ZymA, (2) ASD that was briefly heated to remove organic substances (H-ASD), and (3) OVA in normal saline, or each of the above alone. Pathologic changes, cytological alterations in bronchoalveolar lavage fluid (BALF), changes in inflammatory cytokines and chemokines in BALF, and OVA-specific IgE and IgG1 antibodies in serum were investigated.ResultsExposure to ZymA with or without OVA had no effect on most indicators of lung inflammation. Exposure to H-ASD with OVA increased the recruitment of inflammatory cells to the lungs and the serum levels of OVA-specific IgE and IgG1. The combination OVA+ZymA+H-ASD induced a marked recruitment of eosinophils and upregulation of T helper 2 (Th2) cytokines (interleukin [IL]-4 and IL-13), IL-6, eotaxin/CCL11, and monocyte chemotactic protein (MCP)-3/CCL7 in BALF and OVA-specific IgE in serum. This treatment also induced the most severe pathological changes in the lungs of mice. ZymA was found to boost the effects of H-ASD, thereby exacerbating the OVA-induced allergic inflammation, even though ZymA alone did not have such effect.ConclusionsThe results suggest that fungal elements such as β-1,3-glucan aggravate the allergic inflammation caused by ASD. Our findings may facilitate prophylaxis of some allergic diseases in Asia.

Stimulus over-selectivity describes a phenomenon where only a subset of the relevant stimuli present in the environment, control an individual’s behavior. The current experiment explored the degree to which over-selectivity increases in old age. The level of over-selectivity in a visual discrimination task in 60 individuals aged 60–89 years was assessed, as well as the degree to which this reflected attentional control. In addition, the intellectual functioning and cognitive flexibility of the participants were assessed. Results showed that, as age increased, three effects were revealed: levels of stimulus over-selectivity increased, IQ scores decreased, and cognitive flexibility decreased. However, over-selectivity was not related to IQ or cognitive flexibility, and appeared related most to attentional impairments. Thus, ageing is related to significant declines in effective stimulus control. These effects can have a serious impact on the physical and psychological health of old adults, as well as their quality of life, and, therefore, this area of research warrants further exploration. The results are discussed in relation to the attention-deficit and comparator theory of over-selectivity.

Around 19% of the patients who turn to childhood mental health centers are witnesses to domestic violence. The aim of this study was to evaluate the efficacy of Emotion Regulation and Interpersonal Group Therapy (ERIGT) in a multidisciplinary community program. Specifically, this program addresses domestic violence in reducing post-traumatic and depressive symptoms in children and adolescents who are witnesses to domestic violence. ERIGT was used with 24 patients ranging from 7 to 16 years old. We evaluated at three time points: before treatment, after treatment, and at 3 months following the end of treatment. We observed a reduction in the post-traumatic and depressive symptoms. This was a pilot study carried out with a small sample, but it indicates that ERIGT has the potential to be effective in the treatment of these symptoms.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Perinatal mother and baby units are an essential service for women suffering from perinatal mental illness by allowing the baby to stay with the mother whilst receiving inpatient mental health care. Such units enable the mother to develop a relationship with her baby in a safe and supportive environment whilst caring for her mental health needs and allow her to gain confidence in her role as a mother. This article presents the development of the Brockington Mother and Baby unit and its progressive advancement towards an exemplary service for women suffering from perinatal mental illness. The Brockington Mother and Baby unit (MBU) at South Staffordshire and Shropshire Healthcare Foundation Trust (SSSFT) is celebrating its 10th anniversary and is one of six MBUs accredited as excellent by the Royal College of Psychiatry (RCPsych). The unit is a member of the Royal College of Psychiatrists’ Quality Care Network and thereby adheres to their national standard of care. This article describes the journey from a single lone worker in perinatal mental health to an exemplary service caring for women with perinatal mental illness during the first 12 months following the birth of their child.