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Although reduced working time and furlough policy initiatives are widely regarded as important for economic and business reasons, little is known about their impacts on workers' mental health at the onset of COVID-19 pandemic. Using data from the UK Household Longitudinal Panel Study data from 2018 to February 2020 and April 2020 and change score analysis, this study aims to compare mental health changes between those who worked reduced hours, were furloughed and left/lost paid work. The results suggest that at the onset of COVID-19 reduced working time and furlough can protect workers' mental health, but only for men not for women. The gender differences remain significant even after controlling for housework and childcare responsibilities at the onset of COVID-19. These results highlight the importance of distributing paid work more equitably and formulating gender-sensitive labour market policies in protection of workers' mental health. [ABSTRACT FROM AUTHOR]

Changes in the labour market, high rates of working age poverty, major welfare reforms and more recently the Covid-19 pandemic have drawn renewed attention to income security. Existing research has identified the important role of relational support in helping people cope with low income, but less is known about the role of support for those coping with the potentially destabilising effects of income change which can affect people over relatively short periods of time. This article focuses on how relational coping strategies are utilised by those experiencing such income change. The data are drawn from a qualitative longitudinal study of the experience of income change and insecurity in 15 low-income households in the UK which included repeated in-depth interviews and weekly financial diaries completed in periods of up to five months. The article explores the relational strategies adopted by participants to 'get by' as well as examining how strategies are adopted by those on different levels of low income and with differing networks. The article argues that these strategies illuminate the importance of income change in the experience of low-income households, develop the concept of income insecurity, and provide lessons for policy in providing flexible and responsive support when income changes. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic led to measures that reduced social contact and support. We explored whether UK residents with more frequent or supportive social contact had fewer depressive symptoms during March−August 2020, and potential factors moderating the relationship. Methods: A convenience sample of UK dwelling participants aged ⩾18 in the internet-based longitudinal COVID-19 Social Study completed up to 22 weekly questionnaires about face-to-face and phone/video social contact frequency, perceived social support, and depressive symptoms using the PHQ-9. Mixed linear models examined associations between social contact and support, and depressive symptoms. We examined for interaction by empathic concern, perspective taking and pre-COVID social contact frequency. Results: In 71 117 people with mean age 49 years (standard deviation 15), those with high perceived social support scored 1.836 (1.801–1.871) points lower on PHQ-9 than those with low support. Daily face-to-face or phone/video contact was associated with lower depressive symptoms (0.258 (95% confidence interval 0.225–0.290) and 0.117 (0.080–0.154), respectively) compared to no contact. The negative association between social relationships and depressive symptoms was stronger for those with high empathic concern, perspective taking and usual sociability. Conclusions: We found during lockdown that those with higher quality or more face-to-face or phone/video contact had fewer depressive symptoms. Contact quality was more strongly associated than quantity. People who were usually more sociable or had higher empathy had more depressive symptoms during enforced reduced contact. The results have implications for COVID-19 and potential future pandemic management, and for understanding the relationship between social factors and mental health. [ABSTRACT FROM AUTHOR]

Background: The Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory (BDI-II) and the Generalised Anxiety Disorder Assessment (GAD-7) are widely used in the evaluation of interventions for depression and anxiety. The smallest reduction in depressive symptoms that matter to patients is known as the Minimum Clinically Important Difference (MCID). Little empirical study of the MCID for these scales exists. Methods: A prospective cohort of 400 patients in UK primary care were interviewed on four occasions, 2 weeks apart. At each time point, participants completed all three questionnaires and a 'global rating of change' scale (GRS). MCID estimation relied on estimated changes in symptoms according to reported improvement on the GRS scale, stratified by baseline severity on the Clinical Interview Schedule (CIS-R). Results: For moderate baseline severity, those who reported improvement on the GRS had a reduction of 21% (95% confidence interval (CI) −26.7 to −14.9) on the PHQ-9; 23% (95% CI −27.8 to −18.0) on the BDI-II and 26.8% (95% CI −33.5 to −20.1) on the GAD-7. The corresponding threshold scores below which participants were more likely to report improvement were −1.7, −3.5 and −1.5 points on the PHQ-9, BDI-II and GAD-7, respectively. Patients with milder symptoms require much larger reductions as percentage of their baseline to endorse improvement. Conclusions: An MCID representing 20% reduction of scores in these scales, is a useful guide for patients with moderately severe symptoms. If treatment had the same effect on patients irrespective of baseline severity, those with low symptoms are unlikely to notice a benefit. Funding: Funding. National Institute for Health Research. [ABSTRACT FROM AUTHOR]

Background: The COronaVIrus Disease 2019 (COVID-19) pandemic has led to significant re-organisation of general practice in the United Kingdom and around the world. The general practice workforce has led changes to their services, often dealing with high levels of uncertainty. The way in which many practitioners consult has shifted significantly, and there has been an increase in the number of phone and online consultations. We know very little about how those working in general practice experienced the service reorganisation introduced in the first year of the COVID-19 pandemic. Aim: The aim of this project was to describe the changes in the delivery of general practice in the United Kingdom in the first year of the COVID-19 pandemic. Furthermore, to explore primary care practitioners' and managers' experiences of change within general practice during this time and investigate shifts in perceptions of professional identities. Method: We conducted a longitudinal qualitative study that captured narrative accounts from 17 primary care practitioners and managers across England and Scotland. Each participant submitted narrative accounts in the first year of the COVID-19 pandemic using self-recorded or written contributions, or via an interview if preferred. These were analysed using a grounded theory approach, with thematic coding used to construct common themes. Findings: Participants' narratives describe the challenges COVID-19 presented to general practice. Responses mirror the shifts in the pandemic and its management – from an initial sense of autonomy but uncertainty, to a period of stability and patients' increasing frustration. The re-organisation of general practice has affected practitioners' views of their work and their role as clinicians. Participants' narratives were framed profoundly by the importance of their relationships with patients. This analysis of practitioners' and managers' narratives highlights the need for further exploration of how to support the general practice workforce's well-being longer term in a context of increased demand and significant change. [ABSTRACT FROM AUTHOR]

Universal Credit is the UK's globally innovative social security reform that replaces six means tested benefits with one monthly payment for working age claimants - combining social security and tax credit systems. Universal Credit expands welfare conditionality via mandatory job search conditions to enhance 'progression' amongst working claimants by requiring extra working hours or multiple jobs. This exposes low paid workers to tough benefit sanctions for non-compliance, which could remove essential income indefinitely or for fixed periods of up to three years. Our unique contribution is to establish how this new regime is experienced at micro level by in-work claimants over time. We present findings from Qualitative Longitudinal Research (141 interviews with 58 claimants, 2014-17), to demonstrate how UC impacts on in-work recipients and how conditionality produces a new coerced worker-claimant model of social support. We identify a series of welfare conditionality mismatches and conclude that conditionality for in-work claimants is largely counterproductive. This implies a redesign of the UK system and serves as an international warning to potential policy emulators. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual and queer (LGBQ) women living in the United Kingdom (UK) experience worse health than their heterosexual peers throughout their lives, but less is known about health inequalities in older age. This study uses population-level data to examine inequalities among LGBQ older women and women who prefer not to disclose their sexuality, compared to heterosexual women. Analyses use data from women aged 50 and older who were active in Waves 3 and 7 of the UK Household Longitudinal Study (also known as Understanding Society) (N = 8,209) to examine inequalities in socio-economic conditions, health and alcohol consumption across sexual orientation groups. LGBQ older women are on average younger and have higher socio-economic resources than their heterosexual peers. In contrast, women who prefer not to disclose their sexual orientation are older and have the lowest income and educational qualifications. Results of the health inequalities analyses show that LGBQ older women are almost twice as likely as heterosexual older women to engage in harmful alcohol consumption. Older women who prefer not to disclose their sexuality have worse physical and mental health than heterosexual older women. The health of LGBQ older women and women who prefer not to disclose their sexual orientation is one of the most neglected research areas in UK gerontology. Findings of this study contribute to our understanding of their social and health circumstances, and illuminate methodological limitations in existing data. [ABSTRACT FROM AUTHOR]

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents' attempts to manage this boundary. [ABSTRACT FROM AUTHOR]

The article focuses on investigating the trajectory curves of post-COVID anxiety/depressive symptoms and sleep quality in previously hospitalized COVID-19 survivors. Topics include the prevalence and trajectory of anxiety/depressive symptoms and poor sleep quality in COVID-19 survivors, the potential recovery of anxiety/depressive symptoms over time, albeit slower for poor sleep quality, and the importance of considering delayed-onset symptoms.

Background: Being bullied by a sibling has been recently identified as a potential risk factor for developing depression and self-harm. It is unknown whether this risk extends to other serious mental health problems such as psychosis. We investigated whether sibling bullying victimization or perpetration in middle childhood was prospectively associated with psychotic disorder in early adulthood. Methods: The current study investigated 6988 participants of the Avon Longitudinal Study of Parents and Children, a UK community-based birth cohort. Sibling bullying was reported at 12 years and psychotic disorder was assessed via a semi-structured interview at 18 years. Results: Involvement in sibling bullying was associated with psychotic disorder in a dose-response fashion, even after controlling for a range of confounders. Those involved several times a week were 2–3 times more likely to meet criteria for a psychotic disorder [odds ratio (OR); 95% confidence interval (CI)]: victimization (OR 2.74; CI 1.28–5.87); perpetration (OR 3.16; CI 1.35–7.41). Categorical analysis indicated that particularly victims (OR 3.10; CI 1.48–6.50) and bully-victims (OR 2.66; CI 1.24–5.69) were at increased risk of psychotic disorder. Involvement in both sibling and peer bullying had a dose-effect relationship with a psychotic disorder, with those victimized in both contexts having more than four times the odds for a psychotic disorder (OR 4.57; CI 1.73–12.07). Conclusion: Parents and health professionals should be aware of the adverse long-term effects of sibling bullying. [ABSTRACT FROM AUTHOR]

There is growing concern about the problem of in-work poverty in the UK. Despite this, the literature on in-work poverty remains small in comparison with that on low pay and, in particular, we know relatively little about how people move in and out of in-work poverty. This paper presents an analysis of in-work poverty transitions in the UK, and extends the literature in this field in a number of identified ways. The paper finds that in-work poverty is more transitory than poverty amongst working-age adults more generally, and that the number of workers in the household is a particularly strong predictor of in-work poverty transitions. For most, in-work poverty is a temporary phenomenon, and most exits are by exiting poverty while remaining in work. However, our study finds that respondents who experience in-work poverty are three times more likely than non-poor workers to become workless, while one-quarter of respondents in workless, poor families who gained work entered in-work poverty. These findings demonstrate the limits to which work provides a route out of poverty, and points to the importance of trying to support positive transitions while minimising negative shocks faced by working poor families. [ABSTRACT FROM AUTHOR]

Background. It is well-established that offspring of depressed mothers are at increased risk for suicidal ideation. However, pathways involved in the transmission of risk for suicidal ideation from depressed mothers to offspring are poorly understood. The aim of this study was to examine the contribution of potential mediators of this association, including maternal suicide attempt, offspring psychiatric disorder and the parent-child relationship. Method. Data were utilized from a population-based birth cohort (ALSPAC). Three distinct classes of maternal depression symptoms across the first 11 years of the child's life had already been identified (minimal, moderate, chronic-severe). Offspring suicidal ideation was assessed at age 16 years. Data were analysed using structural equation modelling. Results. There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms compared to offspring of mothers with minimal symptoms (odds ratio 3.04, 95% confidence interval 2.19- 4.21). The majority of this association was explained through maternal suicide attempt and offspring psychiatric disorder. There was also evidence for an independent indirect effect via the parent-child relationship in middle childhood. There was no longer evidence of a direct effect of maternal depression on offspring suicidal ideation after accounting for all three mediators. The pattern of results was similar when examining mechanisms for maternal moderate depression symptoms. Conclusions. Findings highlight that suicide prevention efforts in offspring of depressed mothers should be particularly targeted at both offspring with a psychiatric disorder and offspring whose mothers have made a suicide attempt. Interventions aimed at improving the parent-child relationship may also be beneficial. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this evaluation was to obtain views from general practitioners (GPs) who piloted the electronic risk assessment tools (eRATs) for suspected lung or colorectal cancer. We wanted to find out whether GPs were able to integrate these tools into their everyday practice. We were also keen to identify facilitators and barriers to their more widespread use. Background: Cancer remains one of UK's biggest health problems, in terms of morbidity and mortality. Comparative European data show that five-year survival figures for many cancers are lower in the United Kingdom than in comparable European countries. eRATs are intended to aid recognition of symptoms of lung and colorectal cancers in patients aged 40 years and over. Methods: This was a qualitative study; telephone interviews were conducted with 23 GPs who piloted the eRATs. A systematic qualitative analysis was applied to the data. The normalisation process model was used after data collection. This theory-driven conceptual framework was used to examine the operationalisation of this intervention in Primary Care. Findings: Electronic decision-support tools appear to be useful additions to the resources available to GPs in order to assist them with recognizing potential cancer symptoms. However, the tools need to be refined in order to integrate them into GP practice. The tools raised GPs' awareness about cancer because of the prompt facility of the software, although this also raised the potential of 'prompt fatigue'. GPs constantly receive alerts via their clinical system, particularly related to the Quality and Outcomes Framework. The integration of eRATs into routine practice could be engendered by improvement to the training packages that accompany them, and by its delivery via a platform compatible with all GP clinical systems. [ABSTRACT FROM AUTHOR]

BackgroundA lack of an aetiologically based nosology classification has contributed to instability in psychiatric diagnoses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an incidence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change.MethodData were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables associated with change were examined using logistic regression and likelihood ratio tests.ResultsSlightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years. Many variables were associated with change to schizophrenia but few with overall change in diagnosis.ConclusionsDiagnoses other than schizophrenia should to be regarded as potentially provisional. [ABSTRACT FROM AUTHOR]

BackgroundIdentifying childhood predictors of binge eating and understanding risk mechanisms could help improve prevention and detection efforts. The aim of this study was to examine whether features of attention-deficit/hyperactivity disorder (ADHD), as well as childhood eating disturbances, predicted binge eating later in adolescence.MethodWe studied specific risk factors for the development of binge eating during mid-adolescence among 7120 males and females from the Avon Longitudinal Study of Parents and Children (ALSPAC), a cohort study of children in the UK, using data from multiple informants to develop structural equation models. Repeated assessment of eating disturbances during childhood (mid-childhood overeating, late-childhood overeating and early-adolescent strong desire for food), as well as teacher- and parent-reported hyperactivity/inattention during mid- and late childhood, were considered as possible predictors of mid-adolescent binge eating.ResultsPrevalence of binge eating during mid-adolescence in our sample was 11.6%. The final model of predictors of binge eating during mid-adolescence included direct effects of late-childhood overeating [standardized estimate 0.145, 95% confidence interval (CI) 0.038–0.259, p = 0.009] and early-adolescent strong desire for food (standardized estimate 0.088, 95% CI −0.002 to 0.169, p = 0.05). Hyperactivity/inattention during late childhood indirectly predicted binge eating during mid-adolescence (standardized estimate 0.085, 95% CI 0.007–0.128, p = 0.03) via late-childhood overeating and early-adolescent strong desire for food.ConclusionsOur findings indicate that early ADHD symptoms, in addition to an overeating phenotype, contribute to risk for adolescent binge eating. These findings lend support to the potential role of hyperactivity/inattention in the development of overeating and binge eating. [ABSTRACT FROM AUTHOR]

Background. Tuberous sclerosis complex (TSC) is associated with intellectual disability, but the risk pathways are poorly understood. Method. The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of the natural history of TSC. One hundred and twenty-five UK children age 0-16 years with TSC and born between January 2001 and December 2006 were studied. Intelligence was assessed using standardized measures at ≥2 years of age. The age of onset of epilepsy, the type of seizure disorder, the frequency and duration of seizures, as well as the response to treatment was assessed at interview and by review of medical records. The severity of epilepsy in the early years was estimated using the EChess score. Genetic studies identified the mutations and the number of cortical tubers was determined from brain scans. Results. TSC2 mutations were associated with significantly higher cortical tuber count than TSC1 mutations. The extent of brain involvement, as indexed by cortical tuber count, was associated with an earlier age of onset and severity of epilepsy. In turn, the severity of epilepsy was strongly associated with the degree of intellectual impairment. Structural equation modelling supported a causal pathway from genetic abnormality to cortical tuber count to epilepsy severity to intellectual outcome. Infantile spasms and status epilepticus were important contributors to seizure severity. Conclusions. The findings support the proposition that severe, early onset epilepsy may impair intellectual development in TSC and highlight the potential importance of early, prompt and effective treatment or prevention of epilepsy in tuberous sclerosis. [ABSTRACT FROM AUTHOR]

AimTo evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England.BackgroundResearch suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services.MethodThe intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies.ResultsResults show a significant increase in clinicians’ self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians’ confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services. [ABSTRACT FROM AUTHOR]

BackgroundDo DSM-IV diagnostic criteria for major depression (MD) in Chinese and Western women perform in a similar manner?MethodThe CONVERGE study included interview-based assessments of women of Han Chinese descent with treated recurrent MD. Using Mplus software, we investigated the overall degree of between-sample measurement invariance (MI) for DSM-IV diagnostic criteria for MD in the CONVERGE sample and samples selected from four major Western studies from the USA and Europe matched to the inclusion criteria of CONVERGE. These analyses were performed one pair at a time. We then compared the results from CONVERGE paired with Western samples to those obtained when examining levels of MI between pairs of the Western samples.ResultsAssuming a single factor model for the nine diagnostic criteria for MD, the level of MI based on global fit indexes observed between the CONVERGE and the four Western samples was very similar to that seen between the Western samples. Comparable results were obtained when using a two-factor structure for MI testing when applied to the 14 diagnostic criteria for MD disaggregated for weight, appetite, sleep, and psychomotor changes.ConclusionsDespite differences in language, ethnicity and culture, DSM criteria for MD perform similarly in Chinese women with recurrent MD and comparable subjects from the USA and Europe. The DSM criteria for MD may assess depressive symptoms that are relatively insensitive to cultural and ethnic differences. These results support efforts to compare findings from depressed patients in China and Western countries. [ABSTRACT FROM AUTHOR]

Many older women experience the loss of a spouse or partner in later life. This paper explores older women's experiences of Christmas in order to locate process and meaning in relation to the transition of later life widowhood. Drawing on longitudinal data, derived from three in-depth interviews conducted over 18 months with 26 older widows, this paper presents a number of themes from the women's accounts of their Christmas celebrations and their Christmas cards. The importance of continuity, social relations and autonomy is situated in three emergent themes: ‘Family, intergenerational ties and tradition’, ‘Friendships, organisational ties and reciprocity’ and ‘Personal continuity and activation’. The significance of discontinuity, change and mediation is illustrated through three emergent themes: ‘Christmas as a catalyst for change’, ‘We are all widows’ and ‘Negotiating change with others’. The findings, including the positive aspects of continuity and discontinuity, demonstrate that Christmas is a potent symbol of both personal and social transformation during later life widowhood, and that the management of transition incorporates not only social relations, but also personal agency and flexibility. This paper further challenges the predominantly negative stereotype of older widows and illustrates their resilience and growth in the later stages of life. [ABSTRACT FROM PUBLISHER]

BackgroundStudies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare.MethodAESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews.ResultsAt follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1–4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London.ConclusionsSustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover. [ABSTRACT FROM AUTHOR]

Many older women reduce the amount of cooking and food preparation they do in later life. While cooking may be seen as traditionally associated with women's family roles, little is known about the impact of such reduced engagement with food on their lives. This paper presents the findings from a one-year qualitative study (Changes Around Food Experience, CAFE) of the impact of reduced contact with preparing and cooking meals from scratch for 40 women, aged 65–95 years, living in Norfolk, United Kingdom. Data were collected through semi-structured interviews, focus groups and observations. Women's reasons for reducing food-related activities included changes in health, loss of a partner or a caring role, and new patterns of socialising. Disengagement from cooking and shopping was not found to entail predominantly negative feelings, passive acceptance or searching for forms of support to re-enable more cooking from scratch. Accounts evidenced the dynamic adaptability of older women in actively managing changed relationships with food. In exploring new meal options, older women were not simply disengaging from their environments. CAFE findings linked women's engagement with their environments to how they were using formal services and, even more, to the value they placed on social engagement and being out and about. Through the connections they fostered with friends, family and community, older women actively enabled their continued involvement in their social, public and family spheres. Reduced contact with preparing and cooking meals from scratch, therefore, did not induce or imply passivity or debility in the CAFE cohort. By contrast, it involved their exploring new means of retaining what was important to them about food in the context of their lived situation and social connections with friends, family, the community and public spheres. [ABSTRACT FROM PUBLISHER]

During the early 1960s, Norbert Elias led a research project on the adjustment of young workers to work situations and adult roles. The data from this project, which consisted of 851 interviews with young people, were recently rediscovered and the participants, now approaching retirement, were re-interviewed as part of a restudy. In this paper we argue, that, in the context of the dramatic changes to the transition to retirement that have taken place in the United Kingdom, it is possible to use Elias's unpublished work on the transition to work as a theoretical framework for understanding of the transition from work and to retirement. In particular, we focus on the themes of fantasy and reality in the perception of retirement; changing interdependencies in the transition to retirement and the extent and impact of retirement preparation on the perception of the change in status from full-time worker to retiree. We conclude by suggesting that the implied advantages of being the ‘baby-boomer’ generation are far from the reality, with the experiences of this group being similar to those who have gone before and face an adjustment to retirement marked by uncertainty and anxiety. [ABSTRACT FROM PUBLISHER]

In an increasingly ageing society, its older members are receiving considerable political and policy attention. However, much remains to be learnt about public perceptions of older age, particularly the views and experiences of older individuals themselves. Drawing on qualitative interviews carried out with members of two British cohorts (N = 60) who have reached the ‘third age’, this paper discusses perceptions of age, focusing particularly on how perceived advantages and disadvantages differ by respondents' self-reported physical capability. The interviews were carried out in 2010 as part of the HALCyon (Healthy Ageing across the Life Course) collaborative research programme. Findings suggest there is some difference in the way older people view aspects of ageing by capability and that although advantages are widely perceived, physical decline and associated health concerns were the overwhelming theme across the conversations. The article concludes by making tentative suggestions to inform the positive ageing agenda and its related policies. [ABSTRACT FROM PUBLISHER]

Background Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication. Aims To assess the cost-effectiveness of cognitive-behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone. Method Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYS). Results The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups. Conclusions The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT. [ABSTRACT FROM AUTHOR]

BackgroundThe objective of the present study was to estimate the association between different leisure-time physical activity (LTPA) parameters from 11 to 50 years and cognitive functioning in late mid-adulthood.MethodThe study used a prospective birth cohort study including participants in the UK National Child Development Study (NCDS) from age 11 to 50 years. Standardized z scores for cognitive, memory and executive functioning at age 50 represented the primary outcome measures. Exposures included self-reported LTPA at ages 11, 16, 33, 42, 46 and 50 years. Analyses were adjusted for important confounders including educational attainment and long-standing illness.ResultsThe adjusted difference in cognition score between women who reported LTPA for at least 4 days/week in five surveys or more and those who never reported LTPA for at least 4 days/week was 0.28 [95% confidence interval (CI) 0.20–0.35], 0.10 (95% CI 0.01–0.19) for memory score and 0.30 (95% CI 0.23–0.38) for executive functioning score. For men, the equivalent differences were: cognition 0.12 (95% CI 0.05–0.18), memory 0.06 (95% CI − 0.02 to 0.14) and executive functioning 0.16 (95% CI 0.10–0.23).ConclusionsThis study provides novel evidence about the lifelong association between LTPA and memory and executive functioning in mid-adult years. Participation in low-frequency and low-intensity LTPA was positively associated with cognitive functioning in late mid-adult years for men and women. The greatest benefit emerged from participating in lifelong intensive LTPA. [ABSTRACT FROM PUBLISHER]

BackgroundMany research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores.MethodData from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes.ResultsLCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate–severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning.ConclusionsThe different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms. [ABSTRACT FROM PUBLISHER]

BackgroundLong-term sickness absence (LTSA) is most commonly due to common mental disorders and symptom-based conditions. Relatively little research has examined individual, as opposed to occupational, risk factors for LTSA. Individual appraisal of the workplace has been considered in several studies but self-rated health has more often been examined as a consequence of, rather than as a risk factor for, sickness absence. We aimed to study the association between self-rated health and later LTSA.MethodWe used data from the 1970 British Cohort Study (BCS70). LTSA was defined as being in receipt of Incapacity Benefit (IB)/Severe Disablement Allowance (SDA) at age 34. The mother rated the participant's overall health at age 16; the participants self-rated at age 30. Reports of psychological and somatic symptoms were available at age 16; data on major health conditions were available at age 30.ResultsAnalyses were restricted to those working, studying or caring for children at age 30 (n = 14 105). One hundred and fifty-six (1.1%) were receiving IB or SDA by age 34. After adjustment for social class at birth, educational attainment, health conditions at age 30 and psychological and somatic symptoms at age 16, those who reported their health as poor had more than five times the odds of being long-term sick at age 34.ConclusionsThe overall appraisal of an individual's health as poor, independent of any diagnosis, is a significant vulnerability factor for LTSA. [ABSTRACT FROM AUTHOR]

Spirituality is positively linked to health and well-being in later life, particularly among older adults of black ethnic groups. However, definitions of spirituality in the literature have largely been theoretically informed, rather than based on the views of older people themselves. We examined the spiritual perspectives of Black Caribbean and White British older adults based on in-depth interviews with 34 individuals aged between 60 and 95 years. Our aim was to develop a spiritual typology to add to an understanding of the process of spirituality in later life. Findings showed that Black Caribbean older individuals mostly defined spirituality in relation to their belief in a transcendent God, whereas White British older individuals tended to draw upon a wider range of spiritual, religious or secular notions. A spirituality typology in later life captured four categories of relationship, between ‘God to self’, ‘self to God’, ‘self to universe’ and ‘self to life’. The typology highlights the central role of ethnicity in shaping spiritual perspectives in later life, and identifies the multidimensional nature of spirituality among older adults, reflecting in part a developmental process, although a process which is socially and culturally constructed. [ABSTRACT FROM PUBLISHER]

BackgroundMaternal experience of childhood maltreatment and maternal antenatal depression are both associated with offspring childhood maltreatment and offspring adjustment problems. We have investigated the relative impact of maternal childhood maltreatment and exposure to depression in utero on offspring maltreatment and psychopathology.MethodThe sample included 125 families from the South London Child Development Study. A prospective longitudinal design was used. Data on maternal childhood maltreatment, maternal antenatal depression (36 weeks of pregnancy), offspring childhood maltreatment (age 11 years) and offspring adolescent antisocial behaviour and depression (ages 11 and 16 years) were obtained from parents and offspring through clinical interview.ResultsMothers who experienced childhood maltreatment were significantly more likely to be depressed during pregnancy [odds ratio (OR) 10.00]. Offspring of mothers who experienced only childhood maltreatment or only antenatal depression were no more at risk of being maltreated or having psychopathology; however, offspring of mothers who experienced both maternal childhood maltreatment and antenatal depression were exposed to significantly greater levels of childhood maltreatment and exhibited significantly higher levels of adolescent antisocial behaviour compared with offspring not so exposed. Furthermore, maternal childhood maltreatment accounted for a significant proportion of the variance in offspring childhood maltreatment in only those offspring exposed to depression in utero.ConclusionsMaternal childhood maltreatment and maternal antenatal depression are highly associated. The co-occurrence of both insults significantly increases the risk of offspring adversity. The antenatal period is an optimum period to identify vulnerable women and to provide interventions. [ABSTRACT FROM AUTHOR]

BackgroundIt has been argued that sleep disturbances are a risk factor for depression but previous longitudinal studies have had limitations and not addressed alternative explanations. The aim of this study was to examine the longitudinal association between sleep disturbances and depressive symptoms in a nationally representative sample.MethodData from the 18-month follow-up of the UK National Psychiatric Morbidity survey were used (n = 2406). Sleep disturbances, depressive and other psychiatric symptoms (fatigue, concentration problems, irritability, anxiety and pain symptoms) were assessed using the Revised Clinical Interview Schedule (CIS-R). The bidirectional association between symptoms was investigated with logistic regression analyses and path analysis.ResultsSleep disturbances and depressive symptoms were correlated with each other cross-sectionally (r = 0.52, p < 0.001). In the longitudinal analysis, sleep disturbances at baseline did not predict depressive symptoms at follow-up [odds ratio (OR) 1.27, 95% confidence interval (CI) 0.51–3.19] and the same was observed for the reciprocal association (OR 0.87, 95% CI 0.56–1.35). In the path analysis, the reciprocal model did not have a better fit compared to the simpler first-order model without cross-lagged paths. The path from sleep disturbances at baseline to depressive symptoms at follow-up had a minimal contribution to the explained variance of the latter (<1%).ConclusionsPrevious studies may have overestimated the importance of sleep disturbances as an independent risk factor of depression. The strong cross-sectional association is compatible with sleep disturbances being either a prodromal or a residual symptom of depression and this may have implications for recognition and treatment of depression. [ABSTRACT FROM PUBLISHER]

BackgroundAlterations in reward processing may represent an early vulnerability factor for the development of depressive disorder. Depression in adults is associated with reward hyposensitivity and diminished reward seeking may also be a feature of depression in children and adolescents. We examined the role of reward responding in predicting depressive symptoms, functional impairment and new-onset depressive disorder over time in the adolescent offspring of depressed parents. In addition, we examined group differences in reward responding between currently depressed adolescents, psychiatric and healthy controls, and also cross-sectional associations between reward responding and measures of positive social/environmental functioning.MethodWe conducted a 1-year longitudinal study of adolescents at familial risk for depression (n = 197; age range 10–18 years). Reward responding and self-reported social/environmental functioning were assessed at baseline. Clinical interviews determined diagnostic status at baseline and at follow-up. Reports of depressive symptoms and functional impairment were also obtained.ResultsLow reward seeking predicted depressive symptoms and new-onset depressive disorder at the 1-year follow-up in individuals free from depressive disorder at baseline, independently of baseline depressive symptoms. Reduced reward seeking also predicted functional impairment. Adolescents with current depressive disorder were less reward seeking (i.e. bet less at favourable odds) than adolescents free from psychopathology and those with externalizing disorders. Reward seeking showed positive associations with social and environmental functioning (extra-curricular activities, humour, friendships) and was negatively associated with anhedonia. There were no group differences in impulsivity, decision making or psychomotor slowing.ConclusionsReward seeking predicts depression severity and onset in adolescents at elevated risk of depression. Adaptive reward responses may be amenable to change through modification of existing preventive psychological interventions. [ABSTRACT FROM PUBLISHER]

Background. Retrospective studies have consistently indicated an association between maladaptive parenting and borderline personality disorder (BPD). This requires corroboration with prospective, longitudinal designs. We investigated the association between suboptimal parenting and parent conflict in childhood and BPD symptoms in late childhood using a prospective sample. Method. A community sample of 6050 mothers and their children (born between April 1991 and December 1992) were assessed. Mothers' family adversity was assessed during pregnancy and parenting behaviours such as hitting, shouting, hostility and parent conflict across childhood. Intelligence quotient (IQ) and DSM-IV Axis I diagnoses were assessed at 7-8 years. Trained psychologists interviewed children at 11 years (mean age 11.74 years) to ascertain BPD symptoms. Results. After adjustment for confounders, family adversity in pregnancy predicted BPD probable 1 to 2 adversities: odds ratio (OR) = 1.34 [95% confidence interval (CI) 1.01-1.77]; >2 adversities: OR 1.99 (95% CI 1.34-2.94) and definite 1 to 2 adversities: OR 2.48 (95% CI 1.01-6.08) symptoms. Each point increase in the suboptimal parenting index predicted BPD probable: OR 1.13 (95% CI 1.05-1.23) and definite: OR 1.28 (95% CI 1.03-1.60) symptoms. Parent conflict predicted BPD probable: OR 1.19 (95% CI 1.06-1.34) and definite: OR 1.42 (95% CI 1.06-1.91) symptoms. Within the path analysis, the association between suboptimal parenting and BPD outcome was partially mediated by DSM-IV diagnoses and IQ at 7-8 years. Conclusions. Children from adverse family backgrounds, who experience suboptimal parenting and more conflict between parents, have poor cognitive abilities and a DSM-IV diagnosis, are at increased risk of BPD symptoms at 11 years. [ABSTRACT FROM AUTHOR]

BackgroundCognitive skills programmes have been associated with improvements on psychometric measures and reductions in antisocial behaviour in mentally disordered offenders (MDOs). However, to date there have been no randomized controlled trials (RCTs) of such programmes with this population. In the first RCT of a cognitive skills programme with MDOs we aimed to determine if participation in the Reasoning and Rehabilitation (R&R) programme was associated with improvements in social–cognitive skills and thinking styles.MethodA total of 84 men with a primary diagnosis of psychotic disorder and a history of violence were recruited from medium-secure forensic units and allocated to receive R&R (n=44) or treatment as usual (TAU; n=40). At baseline and post-treatment interviews, participants completed questionnaires to assess social problem-solving, criminal attitudes, anger experience, blame externalizing and perspective-taking. Researchers were not blind to group status.ResultsThe R&R group demonstrated significant improvements on measures of social problem-solving relative to the TAU group, some of which were maintained at 12 months post-treatment. Only half of those allocated to receive R&R completed the full programme. In post-hoc analyses programme completers showed improvements in social problem-solving at the end of treatment and changes in criminal attitudes at 12 months post-treatment.ConclusionsAmong male MDOs, R&R participation was associated with improvements in social–cognitive skills, some of which were maintained for up to 12 months post-treatment. Our finding that programme completers do better may reflect pre-treatment patient characteristics. This study establishes that multi-site RCTs can be conducted in medium-secure forensic units. [ABSTRACT FROM PUBLISHER]

BackgroundIntrusive re-experiencing in post-traumatic stress disorder (PTSD) comprises distressing sensory impressions from the trauma that seem to occur ‘out of the blue’. A key question is how intrusions are triggered. One possibility is that PTSD is characterized by a processing advantage for stimuli that resemble those that accompanied the trauma, which would lead to increased detection of such cues in the environment.MethodWe used a blurred picture identification task in a cross-sectional (n=99) and a prospective study (n=221) of trauma survivors.ResultsParticipants with acute stress disorder (ASD) or PTSD, but not trauma survivors without these disorders, identified trauma-related pictures, but not general threat pictures, better than neutral pictures. There were no group differences in the rate of trauma-related answers to other picture categories. The relative processing advantage for trauma-related pictures correlated with re-experiencing and dissociation, and predicted PTSD at follow-up.ConclusionsA perceptual processing bias for trauma-related stimuli may contribute to the involuntary triggering of intrusive trauma memories in PTSD. [ABSTRACT FROM PUBLISHER]

BackgroundThere are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes.MethodFamily practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile.ResultsThere were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724–0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837–1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654–0.809) in Estonia, 0.811 (95% CI 0.736–0.886) in The Netherlands and 0.707 (95% CI 0.671–0.742) in Chile.ConclusionsPredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression. [ABSTRACT FROM PUBLISHER]

BackgroundBulimic eating disorders are common among female students, yet the majority do not access effective treatment. Internet-based cognitive-behavioural therapy (iCBT) may be able to bridge this gap.MethodSeventy-six students with bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) were randomly assigned to immediate iCBT with e-mail support over 3 months or to a 3-month waiting list followed by iCBT [waiting list/delayed treatment control (WL/DTC)]. ED outcomes were assessed with the Eating Disorder Examination (EDE) at baseline, 3 months and 6 months. Other outcomes included depression, anxiety and quality of life.ResultsStudents who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms.ConclusionsiCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects. [ABSTRACT FROM PUBLISHER]

Background: Individuals in lower socio-economic groups have an increased prevalence of common mental disorders.Aims: To investigate the longitudinal association between socio-economic position and common mental disorders in a general population sample in the UK.Method: Participants (n=2406) were assessed at two time points 18 months apart with the Revised Clinical Interview Schedule. The sample was stratified into two cohorts according to mental health status at baseline.Results: None of the socio-economic indicators studied was significantly associated with an episode of common mental disorder at follow-up after adjusting for baseline psychiatric morbidity. The analysis of separate diagnostic categories showed that subjective financial difficulties at baseline were independently associated with depression at follow-up in both cohorts.Conclusions: These findings support the view that apart from objective measures of socio-economic position, more subjective measures might be equally important from an aetiological or clinical perspective. [ABSTRACT FROM AUTHOR]

A partial N-methyl-D-aspartate agonist, D-cycloserine, enhances fear extinction when given before or shortly after exposure to feared stimuli in animals. In this pilot double-blind placebo-controlled trial (trial number: ISRCTN70977225), 27 youth with obsessive-compulsive disorder were randomised to either 50mg D-Cycloserine or placebo administered immediately after each of ten cognitive-behavioural therapy (CBT) sessions, primarily consisting of exposure and ritual prevention. Both groups improved significantly and maintained their gains at 1-year follow-up, with no significant advantage of D-cycloserine over placebo at any time point. The effects of CBT may not be augmented or accelerated when D-cycloserine is administered after sessions. [ABSTRACT FROM AUTHOR]