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This paper focuses on the experiences of children and young people whose parents employ personal assistant(s) (PAs). It describes findings from a UK‐based qualitative doctoral research study which explored the significance, influence and meaning of the PA role in supporting family life. Ten children and young adults aged 8–28 years with lived experience were interviewed face to face as part of this study, which also explored the perspectives of disabled parents and PAs. Findings reveal that PA support can alter both the quality and nature of the parent/child relationship. The provision of personal assistance can support family life and prevent children from becoming 'young carers'; however, it can also create tension, anxiety and even destabilise family life. [ABSTRACT FROM AUTHOR]

Background: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. Aim and objectives: To measure anxiety that teenagers report 48‐96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. Design: Two‐phase mixed methods, explanatory sequential design. Methods: This single‐site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13‐18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS‐A) was administered on paper and completed with the researcher present. Semi‐structured interviews were conducted in‐person and over the telephone, audio‐recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results: Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48‐96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut‐off level for the HADS‐A‐1 Teenagers described their experiences on PICU within three themes:Memories of treatments, side effects, and the PICU environmentLosing a sense of selfFeeling cared for Conclusions: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. Relevance to clinical practice: Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial. [ABSTRACT FROM AUTHOR]

The stockpiling behaviors during the COVID‐19 pandemic emerged as an example for situations where cooperation is inhibited by lack of trust, media exposure, and increased anxiety. In this paper, I test the hypothesis that stockpiling results from social psychological factors that prevent psychological groupness and cooperation (e.g., low trust in governments and other citizens, high frequency of news exposure, high pandemic anxiety), rather than being an inherently selfish and uncontrollable panic behavior. Specifically, I hypothesized that lower levels of satisfaction with the governments' COVID‐19 policies, lower trust in people in following physical distancing rules, and more frequent media exposure would predict higher stockpiling behaviors through increased pandemic‐related anxiety. In a cross‐sectional survey study conducted in Turkey and the UK during the first‐wave of the pandemic (N = 5137), I tested a conceptual model via SEM. Findings showed that lower trust in people, lower satisfaction with governments' COVID‐19 policies, and high exposure to news predicted higher pandemic related anxiety which predicted higher stockpiling in both countries. I discussed that governments policies and media in both countries may be the reason for mass stockpiling behaviors by decreasing predictability and trust. [ABSTRACT FROM AUTHOR]

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Objectives: Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design: A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods: A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p <.0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p <.0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p <.0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions: Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points: IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures.IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment.A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development. [ABSTRACT FROM AUTHOR]

The "Trojan Horse" scandal laid bare an anxiety at the heart of the British security establishment; an anxiety that brings together questions of identity, values, and security within the demand to manage radicalization. It is an anxiety that, I will argue, reveals a novel conceptualization of threat that has driven the UK's security and communities policies within the "war on terror." This conceptualization emerges within Prevent, the UK's counter-radicalization strategy. Yet, I argue, the extensive literature on Prevent has failed to adequately articulate this underlying, core logic. To date, the Prevent literature has effectively demonstrated the ways in which Muslim communities in the United Kingdom have been policed through British counter-radicalization policy. Yet, this analysis struggles to explain the expansion of Prevent into a wider range of "extremist" spaces. In this article, I contend that it is more useful to situate Prevent as a particular conception of power; a logic and an analysis of threat that demands new forms of government intervention. To do so, this article provides a genealogical reading of Prevent, locating it as a radical extension of state security ambitions to intervene early, making explicit a vision of security in which life as a process of becoming is produced as an object of management. The paper draws out the ramifications of this analysis to think through fundamental shifts in the principles and practices of contemporary security aspirations. [ABSTRACT FROM AUTHOR]

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand-searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak. [ABSTRACT FROM AUTHOR]

Women’s anxieties surrounding breast disorders: a systematic review of the literature A systematic review of the research literature published in English between 1990 and 1999 was carried out to discover whether women with benign breast disorders suffer similar amounts of anxiety to women with breast cancer in the time between discovery of the problem and receiving a diagnosis, to include the immediate postdiagnosis phase. The study was limited to primary research papers with explicit methodology applicable to hospital specialist breast clinics where the main focus of the papers was anxiety and/or psychological distress. Studies focusing exclusively on routine breast screening or exclusively on women with previously diagnosed breast cancer were omitted. A protocol for the review was agreed at the outset, addressing selection criteria, search procedures, methods of data extraction and analysis, and dissemination. Search terms were refined as the study progressed. A data extraction tool was constructed based on Benton and Cormack’s framework (, pp. 80–81). An initial search revealed 89 papers. Fourteen papers were found to meet the criteria for inclusion. The main findings were that women with benign breast disorders and those with breast cancer suffered from similar levels of anxiety and psychological distress in the period from first being aware of the problem up to the time of receiving a diagnosis. Anxiety levels were found to fall more quickly in women with benign disorders postdiagnosis. Methodological flaws were detracted from the rigour of many of the studies. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Little is known about how children themselves understand their moves to and between foster homes. The data presented in this paper come from a study that sought children's views on becoming and being a foster child. A key finding of that study was how children's accounts of being fostered illustrated a high level of anxiety and concern about their moving to live with a foster family. This paper firstly explores the key issues about looked‐after children's moves. It then describes the research study undertaken, before exploring the data generated from children's accounts of their moves to a new foster home. Lastly, there is a discussion of the implications for social work practice in this area. [ABSTRACT FROM AUTHOR]

Aims Whilst there is a considerable body of literature examining the pharmacology of conscious sedation, the social tasks required to successfully provide conscious sedation have not been reported. This paper discusses data regarding the interpersonal work integral to effective conscious sedation provision, from a larger qualitative study exploring how patients and clinicians engage with secondary care conscious sedation provided within the UK. Method Semi-structured interviews were conducted with 13 conscious sedation providers and nine patients within UK-based secondary care sedation settings. Digital audio-recordings were transcribed verbatim and subsequently analysed using a constant comparative method within NVivo Data Analysis Software. Results Four main themes of interpersonal work were reported by participants: displaying care, containing emotions, demonstrating competence and maximizing the effect. Conclusion This study shows that performing conscious sedation requires more than technical delivery, and involves the projection of attributes in a literal 'performance.' The importance of managing outward emotional appearance reflects previous dental research. The need to manage outward appearance, and the emotional impact this has, is of relevance to all clinicians. [ABSTRACT FROM AUTHOR]

Background Mindfulness-based interventions have been shown to be effective in the treatment of a range of health and psychological disorders in adults and young people without intellectual disabilities ( ID). Clinical studies are emerging reporting on the efficacy of mindfulness-based interventions as a stand-alone treatment for common clinical disorders in adults with ID. Method This paper aims to evaluate the efficacy of an innovative structured mindfulness-based cognitive therapy ( MBCT) group programme adapted for adults with ID with a diagnosis of either recurrent depression, anxiety or both clinical conditions and a history of deliberate self-harm behaviour. Two groups ran consecutively consisting of a total of fifteen participants and seven carers. All participants were recorded as having either a borderline, mild, or moderate ID. The group programme ran over a period of 9 weeks with a follow-up session at 6 weeks post group intervention. Outcome measures included the Hospital Anxiety and Depression Scale and two sub-scales from the Self- Compassion Scale administered at baseline, post therapy and at 6-week follow-up. Results The evaluation showed that participants reported an improvement in their experience of depression, anxiety, self-compassion and compassion for others. The most significant impact was in the reduced levels of anxiety reported. Improvements across all outcomes were maintained at 6-week follow-up. Conclusion The results of the evaluation suggest that people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 6-week follow-up. [ABSTRACT FROM AUTHOR]

Introduction: While there is increasing evidence of the effects of cannabis‐based medicinal products (CBMPs) on health‐related quality of life (HRQoL), a major limitation of the current literature is the heterogeneity of studied CBMPs. This study aims to analyze changes in HRQoL in patients prescribed a homogenous selection of CBMPs. Methods: Primary outcomes were changes in patient‐reported outcomes (PROMs) at 1, 3, 6, and 12 months from baseline. The secondary outcome was an adverse events analysis. Statistical significance was defined as p < 0.050. Results: 1378 patients prescribed Adven® CBMPs (Curaleaf International, Guernsey, UK) were included in the final analysis. 581 (42.16%) participants were current users of cannabis at baseline. 641 (46.51%), 235 (17.05%), and 502 (36.43%) patients were treated with oils, dried flowers, or a combination of the two, respectively. Improvements were found in all PROMs in each route of administration at 1, 3, 6, and 12 months from baseline (p < 0.010). Those prescribed dried flower only or both oils and dried flower experienced greater improvements in GAD‐7, SQS, and EQ‐5D‐5L index values at 12 months (p < 0.050). There was no difference in outcomes between those prescribed dried flower only or dried flower with oils (p > 0.050). 3663 (265.82%) adverse events were reported by 297 (21.55%) patients. Conclusion: There was an associated improvement in self‐reported anxiety, sleep quality, and HRQoL in patients treated with the CBMPs. Those prescribed treatment formulations including dried flower were most likely to show a clinical improvement. However, these results must be interpreted with caution given the limitations of study design. [ABSTRACT FROM AUTHOR]

Teaching laboratory practical sessions are major components of undergraduate bioscience curricula, but research into staff perceptions and intentions across institutions in this context is lacking. This study describes a mixed‐methods study using questionnaires and follow‐up interviews to explore staff perceptions of their goals for UK bioscience teaching labs, the extent to which they incorporate student inquiry and challenges encountered with these sessions. The findings show that staff aim for strong lecture connections, applying taught theory to actively develop students' technical and data handling skills. They value teaching labs as opportunities for authentic contact through hands‐on learning with scientific equipment and human connection with staff and other students. Student inquiry (e.g. experimental design decisions) was present in individual elements of teaching labs but not deeply embedded. Staff participants saw teaching labs as first steps to scientific inquiry, often intending to adopt more inquiry activities, but were concerned about time investment and student readiness, especially for early‐year students. Staff who used more inquiry showed stronger goal focus on scientific reasoning, research experience and collaboration. Staff enjoy teaching labs and consider them meaningful learning experiences. Time and budget limitations were more constraining than sense of agency, but overriding challenges were student lab anxieties, and finding ways to increase their confidence and preparation for these sessions. These findings collate staff perceptions of teaching labs across UK institutions and could facilitate reflection, discussion and further research on the goals and impact of these prevalent but resource‐intensive sessions on training the next generation. [ABSTRACT FROM AUTHOR]

Background Religious/spiritual resources may serve multiple functions in adjustment to cancer. However, there is very little evidence of the importance of religious/spiritual variables outside the USA. This paper reports the cross-sectional data of a longitudinal study examining the beneficial and harmful effects of religious/spiritual coping resources on adjustment in the first year after a breast cancer diagnosis. Method One hundred and fifty-five patients newly diagnosed with breast cancer were assessed after surgery. Several aspects of religiousness/spirituality in relation to anxiety and depression were examined: religiosity/spirituality, strength of faith, belief in God, private and public practices, spiritual involvement, perceived spiritual support and positive and negative religious coping strategies. Non-religious coping, social support and optimism were also assessed. Results 'Feeling punished and abandoned by God' significantly explained 5% of the variance in increased levels of anxiety but was partially mediated by denial coping. It was also partially mediated by acceptance coping, lowering levels of anxiety. Feeling punished and abandoned by God was a significant independent predictor of depressed mood, explaining 4% of the variance. Conclusion Using religious/spiritual resources in the coping process during the early stages of breast cancer may play an important role in the adjustment process in patients with breast cancer. Patients may benefit from having their spiritual needs addressed as experiencing some form of religious/spiritual struggle may serve as a barrier to illness adjustment. Implications for research and clinical practices are discussed. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To re-examine various aspects of the benzodiazepines (BZDs), widely prescribed for 50 years, mainly to treat anxiety and insomnia. It is a descriptive review based on the Okey Lecture delivered at the Institute of Psychiatry, King's College London, in November 2010. Methods A search of the literature was carried out in the Medline, Embase and Cochrane Collaboration databases, using the codeword 'benzodiazepine(s)', alone and in conjunction with various terms such as 'dependence', 'abuse', etc. Further hand-searches were made based on the reference lists of key papers. As 60 000 references were found, this review is not exhaustive. It concentrates on the adverse effects, dependence and abuse. Results Almost from their introduction the BZDs have been controversial, with polarized opinions, advocates pointing out their efficacy, tolerability and patient acceptability, opponents deprecating their adverse effects, dependence and abuse liability. More recently, the advent of alternative and usually safer medications has opened up the debate. The review noted a series of adverse effects that continued to cause concern, such as cognitive and psychomotor impairment. In addition, dependence and abuse remain as serious problems. Despite warnings and guidelines, usage of these drugs remains at a high level. The limitations in their use both as choice of therapy and with respect to conservative dosage and duration of use are highlighted. The distinction between low-dose 'iatrogenic' dependence and high-dose abuse/misuse is emphasized. Conclusions The practical problems with the benzodiazepines have persisted for 50 years, but have been ignored by many practitioners and almost all official bodies. The risk-benefit ratio of the benzodiazepines remains positive in most patients in the short term (2-4 weeks) but is unestablished beyond that time, due mainly to the difficulty in preventing short-term use from extending indefinitely with the risk of dependence. Other research issues include the possibility of long-term brain changes and evaluating the role of the benzodiazepine antagonist, flumazenil, in aiding withdrawal. [ABSTRACT FROM AUTHOR]

abstract The Labour government's response to the ) report was to implement the 'Improving Access to Psychological Therapies' (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to 'well-being work' risks distorting the unconscious anxiety-containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of ) and later work by ), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split-off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team. [ABSTRACT FROM AUTHOR]

Like many other UK Dental Schools, Leeds Dental Institute has undertaken a commitment to integrated learning within its new curriculum. From an educational viewpoint, contextualisation of learning presents opportunities for deeper levels of learning. This can be particularly useful in embedding basic sciences in the dental curriculum. The General Dental Council in their document `The First Five Years' endorse this approach to learning. The Year 1 Anxiety and Pain Management course has been designed to integrate basic and clinical sciences, interdisciplinary learning and learning with other members of the dental team. This paper describes the structure of the course, its place within the horizontal and vertical learning themes, as well as describing the response of staff and students to this type of course. [ABSTRACT FROM AUTHOR]

Abstract In modern society natural objects like spiders or snakes have a primary role as the loci of specific phobias. Drawing on interviews with members of the UK National Phobics Society (NPS) and associated service providers, this paper explores the implications of the increasingly significant role played by new media, particularly Virtual Reality technologies, in the treatment of these ‘bio-phobias’. While advanced technological approaches provide new possibilities for individual sufferers to experiment with and control their phobic responses they also exemplify certain aspects of those specifically modern social relations that are the media within which bio-phobic behaviours develop. From a critical sociological perspective the techno-philic move to the medium of cyber-space may actually exaggerate characteristically modern social relations that seek (but never convincingly manage) to assert complete ‘cultural’ control over the unpredictable ‘natural’ elements threatening our cultural integrity. [ABSTRACT FROM AUTHOR]

Background: Recent research has shown that insecure attachment, especially attachment anxiety, is associated with poor mental health outcomes, especially during the COVID‐19 pandemic. Other research suggests that insecure attachment may be linked to nonadherence to social distancing behaviours during the pandemic. Aims: The present study aims to examine the causal links between attachment styles (secure, anxious, avoidant), mental health outcomes (depression, anxiety, loneliness) and adherence to social distancing behaviours during the first several months of the UK lockdown (between April and August 2020). Materials & Methods: We used a nationally representative UK sample (cross‐sectional n = 1325; longitudinal n = 950). The data were analysed using state‐of‐the‐art causal discovery and targeted learning algorithms to identify causal processes. Results: The results showed that insecure attachment styles were causally linked to poorer mental health outcomes, mediated by loneliness. Only attachment avoidance was causally linked to nonadherence to social distancing guidelines. Discussion: Future interventions to improve mental health outcomes should focus on mitigating feelings of loneliness. Limitations include no access to pre‐pandemic data and the use of categorical attachment measure. Conclusion: Insecure attachment is a risk factor for poorer mental health outcomes. [ABSTRACT FROM AUTHOR]

Aims: Assess effectiveness of a hybrid intervention targeting physical activity in women with prior gestational diabetes. Methods: Randomised controlled trial with parallel arms. 293 women (35.1 ± 5.1 years; 40% ethnic minority) recruited from two hospitals and randomised to routine care or hybrid lifestyle intervention comprising two group sessions and access to a mobile web app. Primary outcome was a change in objectively measured physical activity at 12 months. Secondary outcomes included self‐efficacy for exercise, quality of life and anxiety and depression. Linear regression compared outcome measures between groups. Results: 83% of intervention participants attended at least one group session, of who 66% registered to use the app. There was a non‐significant increase in physical activity at 12 months (between‐group difference of 0.95 mg [95% CI: −0.46 to 2.37]), equivalent to approximately 500 steps per day. Intervention participants reported higher self‐efficacy for exercise (0.54, 95% CI: 0.05 to 1.102; p = 0.029), lower anxiety (−0.91, 95% CI: −1.74 to −0.09; p = 0.031), and higher quality of life (0.05, 95% CI: 0.004 to 0.09; p = 0.032), compared to controls. Conclusions: The intervention improved confidence in exercise and quality of life. Further research is needed to improve participant engagement with physical activity interventions in multi‐ethnic populations with a history of gestational diabetes. [ABSTRACT FROM AUTHOR]

This paper examines the practices and perceptions of management consultants and their clients. The existing literature, which emphasizes managerial anxiety in accounting for the persistent use of consultants and, relatedly, the transience of management ideas is critically developed. It is argued that such accounts tend to be abstracted from the power relations of organizations and capitalism and to portray management as passive victims of confident consultants. An alternative interactive model is proposed, which is based on reciprocal and self-defeating concerns of clients and consultants to secure a sense of identity and control. This is explored empirically, highlighting the hitherto neglected active role of managers in resisting consultancy and the pressures and anxieties experienced by consultants. The account selectively draws on secondary sources as well as interview, documentary and survey research of IT strategy consultants and clients in the UK financial services sector. [ABSTRACT FROM AUTHOR]

Objectives: The impact of having a child with diagnosed obsessive–compulsive disorder (OCD) can reportedly cause significant disruption to caregiver routines and negatively affect their mental health. Less is known about the impact to other first‐degree relatives such as siblings due to limited research. It should not be assumed that findings in the caregiver literature can simply be applied to siblings. This study, therefore, aimed to explore the experiences and responses of cohabiting siblings of a brother or sister with an OCD diagnosis. Method: Eight participant siblings were recruited from a UK specialist OCD NHS clinic and interviewed via telephone about their experiences co‐habiting with a brother or sister with OCD. Interviews were transcribed and subjected to interpretative phenomenological analysis (IPA). Results: Two superordinate themes of 'OCD as a dangerous dictator' and the 'unifying/polarising influence of OCD on relationships' were interpreted from the eight participant experiences. Siblings spoke to OCD creating a dictatorial environment characterised by sibling loss, helplessness and adjustment. This fragile domestic environment seemingly pushed non‐anxious siblings to the periphery of the family or conversely centralised their position through parentification. Conclusions: Many of the sibling experiences of frustration, distress avoidance, helplessness and symptom accommodation are mirrored in the burgeoning caregiver literature. Longitudinal studies are required to track sibling experiences over the course of their siblings OCD journey and expand our knowledge in this area. Counselling services, sibling support groups and inclusion in family assessment, formulation and treatment are possible avenues of exploration for siblings of those with an OCD diagnosis. [ABSTRACT FROM AUTHOR]

There have been several arguments for the need to generate evidence‐based creative forms of psychological interventions in Improving Access to Psychological Services (IAPT), the main primary mental health provider in hospitals in England, UK. In this feasibility study, we sought to identify helpful and unhelpful factors of a new creative group psychotherapy, titled Arts for the Blues. We also wanted to find out whether the research tools used were acceptable and sensitive. We therefore engaged a group of seven patients attending an IAPT service in the North West of England, and a group of six staff working in the same service, to attend one creative workshop each, followed by a focus group. The two focus groups were transcribed and analysed using thematic analysis. We also collected pre‐ and post‐measures of depression (PHQ‐9) and anxiety (GAD‐7), measures commonly used in IAPT services, plus measures of well‐being (WHO‐5), the PANAS, and goal‐setting, which were considered for acceptability and sensitivity. We received largely positive responses from service users and staff in the use of creative methods in psychotherapy. Although the measures used had limitations due to the short duration of one‐off creative workshops, we found that they were sensitive enough, easy to complete and, thus, were acceptable. We concluded that Arts for the Blues is a promising intervention in IAPT, especially since it is shaped by service users and staff working in these services. Further work is needed to establish the effectiveness of this new intervention. [ABSTRACT FROM AUTHOR]

Context North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. Objectives The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. Methods A systematic review was conducted using search terms encompassing psychological distress amongst medical students. Ovid SP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; Psyc INFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. Results The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Conclusions Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students. [ABSTRACT FROM AUTHOR]

Test anxiety can have a deleterious impact on academic achievement and adversely affect adolescent well‐being, both concurrently and in later life. The current study explored the use of compassionate mind training (CMT) as a school‐based intervention for test anxiety among adolescents. Participants were 47 adolescents, aged 16–17 years, attending a post‐primary school in the UK and enrolled to take qualifications beyond compulsory education. Participants were quasi‐randomly allocated on the basis of timetable availability into an intervention group that received eight sessions of CMT (n = 22) or a control group (n = 25). Participants in both groups completed pre‐ and post‐intervention measures of test anxiety, general anxiety and self‐compassion. Attendance and retention rates were used as an index of intervention feasibility. The findings indicated that CMT was a feasible and effective intervention. Adolescents receiving CMT showed significant reductions in test anxiety and general anxiety, as well as a significant improvement in self‐compassion following the intervention compared with the control group. The findings highlight the potential value of CMT in supporting young people suffering from test anxiety in schools. The implications for counselling practice are discussed. [ABSTRACT FROM AUTHOR]

Mutual aid groups developed and mobilized in communities across the UK and globally at the outset of the pandemic in order to support vulnerable community members with practical assistance and emotional support, with some understanding their work in political terms. This study adopted a "social cure" lens to investigate the effects of group identification and group perceptions on anxiety and coping self‐efficacy among members of UK Covid‐19 mutual aid groups. Survey data were collected from self‐identified members of these groups (N = 844) during the initial period of "lockdown" restrictions in April – May 2020. Correlational analyses showed that identification with the mutual aid group was linked to more positive group perceptions and better self‐reported psychological outcomes. Perceived group politicization showed the reverse pattern. Mixed support for the "social cure" model was evident; the effect of group identification on coping self‐efficacy (but not anxiety) was serially mediated by perceived support and collective efficacy. Perceived group politicization was a significant moderator, seeming to amplify the indirect effect of group identification on coping self‐efficacy via perceived support. Results are discussed in light of previous empirical work on the social cure and Covid‐19 mutual aid groups. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Background and aims: In Great Britain, cannabis and tobacco are commonly used substances, both independently and together. Use of either substance is associated with mental health problems, but prevalence of co‐use within these populations is unknown. We aimed to (1) estimate prevalence of cannabis use, frequency of use and routes of administration (ROA) among tobacco smokers and non‐smokers and (2) investigate mental health problems among non‐users, tobacco‐only, cannabis‐only and co‐users of both substances. Design Cross‐sectional national on‐line survey (Action on Smoking and Health) fielded in February–March 2020. Setting: Great Britain. Participants: Adults in Great Britain aged ≥ 18 years (n = 12 809) Measurements Tobacco use status [smoker (daily or non‐daily) or non‐smoker (never or ex‐smoker)], cannabis use frequency (never to daily), detailed ROAs of cannabis, self‐reported treatment for mental health disorders (depression, anxiety and any). Statistically weighted prevalence estimates were computed to ensure representativeness. Correlates were assessed using χ2 tests and logistic regression. Findings In Great Britain in 2020, 7.1% of the sample had used cannabis in the past year. Tobacco smokers had greater odds of using cannabis in the past year (21.9%) and using cannabis daily (8.7%) than non‐smokers [past‐year: 4.7%; adjusted odds ratio (aOR) = 10.07, 95% confidence interval (CI) = 8.4–12.0; daily: 0.7%; aOR = 24.6, 95% CI = 18.0–33.6)]. Co‐administration with tobacco was common (46.2% of non‐smokers, 80.8% of tobacco smokers). Co‐users reported the highest prevalence of any treatment for mental health problems (54.2%) in comparison to cannabis‐only (45.8%), tobacco‐only (33.2%) and non‐users (22.7%; all P ≤ 0.05). Conclusion: Approximately one in 13 adults in Great Britain reports having used cannabis in the past year, approximately four times as many among cigarette smokers as non‐smokers. Co‐administration of cannabis and tobacco, via smoking, appears to be common, including among self‐identified non‐smokers. Mental health problems appear to be particularly common among dual users. [ABSTRACT FROM AUTHOR]

Accessible Summary: This research explored the experience of four fathers of autistic children who also have learning disabilities.Fathers' experiences as carers are increasingly recognised in the literature; however, the studies of parental experience tend to centre mothers. The current research builds upon the recent and important focus upon fathers' experiences.The fathers in this study sometimes felt helpless and unable to fulfil the traditional role as protectors and providers, but they also had strong feelings of closeness with their children and developed new identities through the challenges and joys they experienced alongside their children. Background: This small study explores the lived experience of four UK‐based fathers (one black British, one white Polish and two white British) caring for at least one child with a dual diagnosis of learning disability and autism. The key aim was to get as close as possible to understanding the experience of these fathers in their role as carers. Methods: The study makes use of interpretative phenomenological analysis (IPA) as an approach to gathering (via interview) and making sense of the fathers' experiences. Findings and discussion: We co‐constructed three themes following analysis of the interview transcripts: "fatherhood: not doing enough, not doing it right"; "crossing worlds: relearning how to communicate and reclaiming fatherhood"; and "uncertain futures." We found that, for these fathers, the experiences of anxiety and helplessness were balanced with the appreciation of their value as protectors, their shifting sense of identity and of their closeness with their children. Relationships were central throughout. Conclusions: The exploration of fathers' experiences helps to highlight the less‐measurable, nuanced aspects of the joys and challenges of caring for children with dual diagnoses of learning disability and autism which might be used to enhance the support provided and to inform new approaches. [ABSTRACT FROM AUTHOR]

Summary: Background: End‐of‐life discussions are associated with improved quality of care for patients. In the UK, the General Medical Council outlines a requirement for medical graduates to involve patients and their families in discussions on their care at the end‐of‐life. However medical students feel ill‐equipped to conduct these discussions. Methods: In 2018, Sheffield Medical School introduced a small group role‐play session on end‐of‐life discussions for all final year medical students. Scenarios were devised to improve confidence in the following learning domains: communicating prognosis with patients and family; ascertaining patient's goals, values and preferred place of death; discussing escalation of treatment, discussing do not attempt resuscitation orders, care in the dying phase of illness and pre‐emptive prescribing. Evaluation was conducted over 16 weeks with a before and after questionnaire. Students rated their confidence in the above learning domains on a Likert‐style scale and explained their ratings in free‐text boxes. Results: There was a 76% response rate to the questionnaire and analysis showed statistically significant improvements in confidence across all learning domains following the session. Qualitative analysis of free‐text responses showed that prior to the sessions, students expressed low confidence due to lack of experience and fear of upsetting patients. After the session students felt they had gained skills but expressed persistent anxiety and a desire for further practice. Conclusions: Our innovation suggests that the opportunity to experience End‐of‐life discussions through role‐play can significantly improve students' confidence in conducting these conversations. However, repeated sessions are likely necessary for students to feel prepared upon graduation. [ABSTRACT FROM AUTHOR]

Background: Limited research has examined the impact of peanut allergy (PA) on children using validated instruments to assess psychosocial burden and the factors influencing burden. Objective: The PAPRIQUA study aimed to assess the caregiver‐reported impact of living with PA on children's health‐related quality of life (HRQL), correlations between PA severity and child's sex, and associations of caregivers' sex and anxiety with the proxy report of their child's HRQL and to identify significant predictors of a child's HRQL. Methods: A cross‐sectional survey of caregivers of children with mild, moderate and severe PA, based on caregiver perception, was conducted in the United Kingdom. Participants were recruited through a survey recruitment panel; a maximum quota of 20% who rated their child's PA as mild was set to ensure population diversity; however, the quota was not required as few participants considered their child's PA mild. The survey, funded by Aimmune Therapeutics, included sociodemographic and clinical questions, the EQ‐5D‐Y, Hospital Anxiety and Depression Scale, Food Allergy Quality of Life Questionnaire‐Parent Form (FAQLQ‐PF) and Food Allergy Independent Measure (FAIM). Results: One hundred caregivers of children with PA (aged 4‐15 years) completed the survey. Child's sex was not associated with proxy‐reported burden. For younger children (aged 4‐10 years), there was no effect of PA severity; parents of older children (aged 11‐15 years) reported low to higher burden for their child on the EQ‐5D‐Y and FAQLQ‐PF dependent upon PA severity. For all measures of child burden except the EQ‐5D‐Y, two or more reactions in the past 12 months and parental anxiety significantly predicted higher levels of burden for the child (P <.05–P <.001). Experiencing a life‐threatening event in the past 12 months significantly predicted EQ‐5D‐Y proxy utility (P <.01). Conclusions and Clinical Relevance: Caregivers report that children with PA experience high levels of psychosocial burden, particularly those with more severe PA and a reaction history. Interventions to decrease caregiver anxiety and reaction frequency may help reduce the child's burden. Self‐report studies in children with PA would help confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives Public behaviour change is necessary to contain the spread of coronavirus (COVID-19). Based on the reinforcement sensitivity theory (RST) framework, this study presents an examination of individual differences in some relevant psychological factors. Design Cross-sectional psychometric. Methods UK respondents (N = 202) completed a personality questionnaire (RST-PQ), measures of illness attitudes, concerns about the impact of coronavirus on health services and socio-economic infrastructures, personal safety, and likelihood of voluntary self-isolation. Results Respondents most concerned were older, had negative illness attitudes, and scored higher on reward reactivity (RR), indicating the motivation to take positive approach action despite prevailing worry/anxiety. Personal safety concerns were highest in those with negative illness attitudes and higher fight-flight-freeze system (FFFS, reflecting fear/avoidance) scores. Results suggest people are experiencing psychological conflict: between the urge to stay safe (FFFF-related) and the desire to maintain a normal, pleasurable (RR-related) life. Ways of ameliorating conflict may include maladaptive behaviours (panic buying), reflecting reward-related displacement activity. Intended self-isolation related to FFFS, but also low behavioural inhibition system (related to anxiety) scores. Older people reported themselves less likely to self-isolate. Conclusions Interventions need to consider individual differences in psychological factors in behaviour change, and we discuss relevant literature to inform policy makers and communicators. Statement of contribution What is already known on this subject? Reinforcement sensitivity theory (RST) personality systems can influence perception of persuasive health messages. However, there is limited evidence for their direct effects on health concerns and behaviours, and none relating to specific infectious diseases. What does this study add? Reward reactivity (RR) is associated with concern about impact of coronavirus on the NHS and other social infrastructures, indicating the motivation to take positive-approach action despite worry/anxiety. Personal safety concerns are related to fight-flight-freeze system traits (FFFS, reflecting fear/avoidance). Intended self-isolation related to FFFS, but also low behavioural inhibition system (related to anxiety) scores. Older people reported themselves less likely to self-isolate. Results suggest psychological conflict: between the urge to stay safe (FFFF-related) and the desire to maintain a normal, pleasurable life (RR-related). Ways of ameliorating conflict may include maladaptive behaviours (panic buying), reflecting reward-related displacement activity. [ABSTRACT FROM AUTHOR]

Objective: Troublesome hot flushes and night sweats (HFNS) are experienced by many women after treatment for breast cancer, impacting significantly on sleep and quality of life. Cognitive behavioural therapy (CBT) is known to be effective for the alleviation of HFNS. However, it is not known if it can effectively be delivered by specialist nurses. We investigated whether group CBT, delivered by breast care nurses (BCNs), can reduce the impact of HFNS.Methods: We recruited women with primary breast cancer following primary treatment with seven or more HFNS/week (including 4/10 or above on the HFNS problem rating scale), from six UK hospitals to an open, randomised, phase 3 effectiveness trial. Participants were randomised to Group CBT or usual care (UC). The primary endpoint was HFNS problem rating at 26 weeks after randomisation. Secondary outcomes included sleep, depression, anxiety and quality of life.Results: Between 2017 and 2018, 130 participants were recruited (CBT:63, control:67). We found a 46% (6.9-3.7) reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% (6.5-5.5) reduction in the UC arm (adjusted mean difference -1.96, CI -3.68 to -0.23, P = .039). Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly.Conclusion: Our results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting. [ABSTRACT FROM AUTHOR]

Background and purpose: Visual snow syndrome is a recently described condition of unknown prevalence. We investigated the prevalence in a representative population sample from the UK and tested the hypothesis that visual snow syndrome is associated with young age, headache, tinnitus and mood impairment. Methods: Using a crowdsourcing platform, we recruited a representative sample of 1015 adult laypeople from the UK, matched for age, gender and ethnicity according to national census data. Participants were unprimed, i.e. were inquired about the 'frequency of certain medical conditions' but not 'visual snow syndrome'. Results: A total of 38 of 1015 participants reported symptoms compatible with visual snow [3.7%; 95% confidence interval (CI), 2.7–5.2] and 22/1015 met criteria for visual snow syndrome (2.2%; 95% CI, 1.4–3.3). The female‐to–male ratio for visual snow syndrome was 1.6:1. Subjects with visual snow syndrome were older (50.6 ± 14 years) than the population mean (44.8 ± 15 years), although this was not statistically different (P = 0.06). Of 22 participants with visual snow syndrome, 16 had mood symptoms (72.7%; P = 0.01), 12 had headache (54.5%; P = 0.06), including five with visual migraine aura (22.7%; P = 0.15) and 13 had tinnitus (59.1%; P < 0.001). No participant had diabetes or a cleft lip (control questions). Following a multivariable regression analysis to adjust for age and gender, only the association between visual snow syndrome and tinnitus remained significant (odds ratio, 3.93; 95% CI, 1.63–9.9; P = 0.003). Conclusions: The UK prevalence of visual snow syndrome is around 2%. We confirmed an association with tinnitus, but unprimed laypeople with visual snow syndrome are on average older than those seeking medical attention. [ABSTRACT FROM AUTHOR]

Objective: To estimate prevalence of lifetime and current eating disorders (ED) in a sample of pregnant women in South‐East London and to describe their sociodemographic and clinical characteristics. Method: Secondary analysis of data from a cross‐sectional survey. Using a stratified sampling design, 545 pregnant women were recruited. Diagnostic interviews were administered to assess lifetime and current ED, depression, anxiety, and borderline personality disorder. Data were extracted from maternity records to assess identification of ED in antenatal care. Estimates of population prevalence of ED were obtained using sampling weights to account for the stratified sampling design. Results: Weighted prevalence of lifetime ED was 15.35% (95% confidence interval [CI] [11.80, 19.71]), and current ED was 1.47% (95% CI [0.64, 3.35]). Depression, anxiety, and history of deliberate self‐harm or attempted suicide were common in pregnant women with ED. Identification of ED in antenatal care was low. Conclusions: Findings indicate that by early pregnancy, a significant proportion of pregnant women will have had ED, although less typically during pregnancy, and psychiatric comorbidity is common. Yet ED were poorly recognised in antenatal care. The findings highlight the importance of increasing awareness about maternal ED to improve identification and response to the healthcare needs of pregnant women with ED. Three key highlights: Weighted prevalence of lifetime eating disorders was 15.35% (95% CI [11.80, 19.71]), and current eating disorders was 1.47% (95% CI [0.64, 3.35]) in a UK inner‐city antenatal sample; however, eating disorders were poorly recognised in antenatal care.Depression, anxiety, and a history of deliberate self‐harm or attempted suicide are common amongst pregnant women with eating disorders.Findings highlight the clinical importance of increasing awareness about maternal eating disorders in maternity professionals to improve identification and response to the healthcare needs of pregnant women with eating disorders. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. Methods: A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven‐item [GAD‐7] scale) and guideline‐recommended treatments used to manage pain. Clinical anxiety was defined by a GAD‐7 score of 10 or more. Results: A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The number of pain sites was also positively associated with clinical anxiety (four versus one site; OR 3.64, 95% CI 3.09 to 4.30). Those with clinical anxiety were less likely to undertake general fitness exercises (OR 0.60, 95% CI 0.52 to 0.70), but more likely to diet (OR 1.43, 95% CI 1.21 to 1.69), use walking aids (OR 1.53, 95% CI 1.32 to 1.77) and assistive devices (OR 1.24, 95% CI 1.04 to 1.49), and more likely to use opioids (OR 1.34, 95% CI 1.18 to1.52). Conclusions: Anxiety is common among patients presenting to primary care with joint pain. Patients with anxiety are likely to manage their joint pain differently to those without. Case‐finding to identify and treat anxiety would be appropriate in this population, with caution about opioid prescribing and consideration of exercise as an intervention. [ABSTRACT FROM AUTHOR]

Background Sexual minority adolescents (i.e. youth not exclusively heterosexual) report more anxiety than heterosexual youth on symptom questionnaires but no research has used standardised diagnostic tools to investigate anxiety disorder risk. This study uses a UK birth cohort to investigate the risk of anxiety disorders in sexual minority and heterosexual youth using a computerised structured clinical interview and explores the influence of gender nonconformity, bullying and self-esteem. Methods Participants were 4,564 adolescents (2,567 girls and 1,996 boys) from the Avon Longitudinal Study of Parents and Children ( ALSPAC). Logistic regression analyses were performed to investigate the association between sexual orientation at 15.5 years and the presence of an anxiety disorder at 17.5 years. Covariates including maternal occupation, ethnicity, mother-reported childhood gender nonconformity at 30, 42 and 57 months, child-reported gender nonconformity at 8 years, child-reported bullying between 12 and 16 years and self-esteem at 17.5 years were added sequentially to regression models. Results Sexual minority adolescents (i.e. those not exclusively heterosexual) had higher early childhood gender nonconformity ( CGN), lower self-esteem and reported more bullying than adolescents identifying as 100% heterosexual. Minority sexual orientation at 15.5 years was associated with increased risk of an anxiety disorder at 17.5 years for girls ( OR 2.55, CI 1.85-3.52) and boys ( OR 2.48, CI 1.40-4.39). Adjusting for ethnicity, maternal occupation, mother-reported and child-reported CGN had minimal impact on this association. Adjusting for bullying between 12 and 16 years and self-esteem at 17.5 years reduced the strength of the associations, although the overall association remained significant for both sexes (girls OR 2.14 and boys OR 1.93). Conclusions Sexual minority youth are at increased risk of anxiety disorders relative to heterosexual youth at 17.5 years. Bullying between 12-16 years and lower self-esteem may contribute to this risk. [ABSTRACT FROM AUTHOR]

Children's reports about their play in middle childhood and the emotions they associate with play have received limited research attention. Using focus groups, this study asked 38 children in the UK about what, where and with whom they played. They were also asked how play made them feel. Children reported a wide range of play behaviours, with outdoor and traditional games being just as prominently mentioned as play with electronic devices. The emotional importance of play in middle childhood was apparent, with children associating play with strong positive emotions, and not being able to play with negative emotions and anxiety. [ABSTRACT FROM AUTHOR]

Rationale Given the high number of young adults caring for a family member, and the potential for adverse psychosocial outcomes, there is a need for a screening tool, with clinical utility, to identify those most vulnerable to poor outcomes and to aid targeted interventions. Objectives (i) To determine whether current knowledge from cancer literature regarding young carers is generalisable to chronic conditions and, therefore, whether an existing screening tool could be adapted for this population. (ii) To develop a measure of unmet needs in this population and conduct initial psychometric analysis. Design This was mixed method; interviews in study one informed measure development in study two. Inclusion criteria were as follows: having a parent with a chronic condition and being aged 16-24 years. In study 1, an interpretative phenomenological analysis was conducted on interviews from seven young adults (age range 17-19 years). Study 2 explored factor structure, reliability and validity of the Offspring Chronic Illness Needs Inventory ( OCINI). Participants were 73 females and 34 males (mean ages 18.22, SD = 1.16; 18.65, SD = 1.25). Main outcome measures OCINI, Depression Anxiety and Stress Scale, and the Adult Carers Quality of Life Scale. Results Interviews communicated that the impact of their parent's condition went unacknowledged and resulted in psychosocial, support and informational needs. An exploratory principal axis analysis of the OCINI yielded five factors. Significant and positive correlations were found between unmet needs and stress, anxiety, and depression, and inversely with quality of life. Conclusions The scale has applications in clinical settings where these young people, who are at risk of negative psychological outcomes, may be assessed and unmet needs targeted appropriately. [ABSTRACT FROM AUTHOR]

Objectives An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV. Methods The ASTRA study is a cross-sectional questionnaire study of 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011-2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ-9 and GAD-7, respectively), and health-related functional problems (problems on at least one of three domains of the Euroqol 5D-3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity. Results The age distribution of participants was: < 30 years, 5%; 30-39 years, 23%; 40-49 years, 43%; 50-59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio ( OR) for trend across age groups, 0.96; 95% confidence interval ( CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems ( P < 0.001 for trends, adjusted analysis). Conclusions Among people living with HIV, although health-related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life. [ABSTRACT FROM AUTHOR]

Baby‐led weaning, where infants self‐feed family foods in place of traditional spoon‐feeding of purees, is continuing to grow in popularity. Evidence is emerging which suggests that the method may promote healthier eating behaviour and weight gain in children, but the research is in its infancy. One issue is the self‐selecting nature of participants to the approach. Although those who follow a baby‐led approach are known to have a higher education and more professional occupation, little is known about wider maternal characteristics, which might affect either adoption of or outcomes of the method. The aim of this study was to explore differences in maternal characteristics between those adopting a baby‐led or traditional approach. Six hundred four mothers with an infant aged 6–12 months completed a questionnaire including a copy of the Dutch Eating Behaviour Questionnaire (DEBQ), Brief Symptom Inventory (BSI) (anxiety, obsessive–compulsive and depression scales) and Ten Item Personality Questionnaire (TIPQ) alongside details of weaning approach (baby‐led vs. traditional). Mothers who adopted a baby‐led weaning style scored significantly lower on restrained eating (DEBQ), anxiety and introversion (TIPQ) and anxiety and obsessive–compulsive symptoms (BSI). Mothers who currently adopt a baby‐led approach are therefore significantly different in personality, eating behaviour and well‐being characteristics compared with those adopting a traditional approach. These characteristics may affect likelihood of choosing a baby‐led approach or indirectly affect outcomes for infants weaned using the approach. Further research exploring baby‐led weaning in a wider population sample is needed. [ABSTRACT FROM AUTHOR]

Background Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear. Method Prospective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon-Longitudinal-Study-of-Parents-and-Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function ( EF) at age 8, and academic achievement at the end of compulsory school at age 16. Results Adolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a 'pass' grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p < .001) of the association with postnatal depression, and working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams. Conclusion Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents' academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but if these pathways are causal, improving EF could reduce underachievement in math. [ABSTRACT FROM AUTHOR]

The transition to secondary school is a common cause of stress and anxiety, which can be exacerbated by the innate characteristics associated with Asperger syndrome (AS) and high-functioning autism (HFA). This study aimed to explore experiences of the transition to secondary school for students with AS/HFA from the parental perspective. Seventeen parents of children with AS/HFA from the north of England completed an online questionnaire about their child's school transitional experience. Responses indicated that there were a number of factors that influenced the experiences of pupils with AS/HFA at school and the preceding transition, including anxiety, bullying, friendship and support at school. Girls with AS/HFA presented with unique issues not commonly seen in the male dominated condition. The transition to secondary school was seen to encompass a number of difficulties for students with AS/HFA. Health and educational services can learn from the experiences explored in this survey in order to inform future practice. [ABSTRACT FROM AUTHOR]

Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University. AM [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In the treatment research literature on other psychological disorders, there is a move towards session-by-session symptom measurement. The necessary measures need to be brief, focused on core features since the last session, and readily available to clinicians. There is no measure in the eating disorders that meets those criteria. This research reports the development and validation of such a self-report questionnaire. Method The authors generated and refined a brief set of attitudinal and behavioral items. The resulting questionnaire (the ED-15) and an existing measure (Eating Disorders Examination-Questionnaire; EDE-Q) were completed by a large nonclinical adult sample ( N = 531), a group of self-reported eating disorder sufferers ( N = 63), and a group of women ( N = 33) diagnosed with bulimia nervosa or atypical bulimia nervosa and undertaking cognitive-behavioral therapy. Results Factor analysis identified two scales (Weight and Shape Concerns; Eating Concerns), with strong internal consistency and test-retest reliability. Correlations with the EDE-Q ( r = 0.889) indicates that the ED-15 and EDE-Q measure near-identical constructs. The ED-15 differentiated self-reported eating-disordered and nonclinical groups to the same degree as the longer EDE-Q. Session-by-session analysis of the CBT treatment group demonstrated that the different ED-15 scales changed in different patterns across therapy. Discussion The ED-15 is not proposed as an alternative to existing measures, but as a complementary tool, used to measure session-by-session change for clinical and research purposes. Future research will track changes in ED-15 scores across therapy, to determine the importance of very early response to therapy and sudden changes. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1005-1015). [ABSTRACT FROM AUTHOR]

Background: Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim: The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. Method: On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10-18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. Results: All three measures had high internal consistency (alpha = 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r =0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). Conclusion: The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. [ABSTRACT FROM AUTHOR]

Background Increased intensities of routinised and compulsive-like behaviours are seen in those with intellectual disabilities and have sometimes been shown to be associated with worries. We used the Childhood Routines Inventory (CRI, Evans et al., 1997) with two samples of children and adults with Down syndrome: (1) to determine whether routinised and compulsive-like behaviours were associated with mental health problems and (2) to determine the factor structure of the CRI. Method Parents or carers completed the CRI for (1) 125 adults with Down syndrome (aged 18-43 years) who had been assessed for mental health problems; worries and fears were also rated by parents/carers and (2) 206 individuals with Down syndrome (aged 4.5-43 years, with verbal mental ages of 2 years and above). Results (1) People with a psychiatric diagnosis had significantly more worries and fears than those without such a diagnosis, but there was no significant difference in CRI scores. Logistic regression indicated that the fear rating was the only significant predictor of a diagnosis. (2) Exploratory and confirmatory analyses showed a three-factor model (Just right, Repetitive behaviour and Clothes sensitivity) to be the best solution. Those with psychiatric diagnoses had significantly higher ratings on the Repetitive behaviour factor. Conclusion Increased levels of routinised and compulsive-like behaviours were shown by individuals with Down syndrome of all ages, were not associated with mental health problems, but were associated with worries and fears. Factor analysis found three factors, two of which (Just right and Repetitive behaviours), were similar to those identified in typically developing samples. This suggests that the behaviours have similar adaptive functions in individuals with developmental delays. [ABSTRACT FROM AUTHOR]

Background The increased availability of caffeinated drinks raises questions about the level of caffeine that is appropriate for children, as well as the benefits and risks associated with their consumption. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, this systematic review evaluates evidence from randomised controlled trials investigating the effects of caffeine on cognition, behaviour, mood and exercise performance in children. Observational studies and expert panel guidelines are also discussed. Results One hundred and nine studies were found, with 11 randomised controlled trials and 13 observational studies meeting the criteria. High caffeine intakes (e.g. >5 mg kg-1 body weight day-1) were associated with an increased risk of anxiety and withdrawal symptoms. However, smaller amounts were not linked with such effects and may benefit cognitive function and sports performance based on adult studies. The evidence suggests that children and adolescents should limit daily caffeine consumption to 2.5 mg kg-1 body weight day-1, equating to one or two cups of tea or one small cup of coffee. Lower contributors of caffeine, such as tea, may be more appropriate for children because they contribute to daily fluid intakes and provide flavonoids. By contrast, caffeinated soft drinks may be less suitable options for children as a result of their acidity, higher caffeine content, presence of added sugar (in some cases) and absence of bioactive compounds. Conclusions More studies are needed to determine the intakes that represent a risk and whether there may be benefits for alertness and sports performance with moderate intakes of caffeine. [ABSTRACT FROM AUTHOR]

Background Weight management interventions can be extended using mobile telephone technology to deliver support in real-time, real-world settings. The present study aimed to determine whether text messaging helped patients maintain or lose weight following a weight-loss programme. Methods In this controlled study, overweight and obese [ body mass index ( BMI) >30 kg m-2 or >28 kg m-2 with co-morbidities] adults who completed a weight-loss programme participated in an additional 12-week text message intervention [ Lifestyle, Eating and Activity Programme ( LEAP) Beep]. Patients were allocated goals for steps, fruit, vegetable and breakfast consumption. Patients regularly 'texted' their progress and received tailored practitioner feedback. Pre/post-intervention body weight, waist circumference ( WC), BMI, quality of life ( QOL), anxiety and depression measurements were compared retrospectively with a control group offered weight checks only. Results Compared to control ( n = 17), the intervention group's ( n = 17) body weight, WC and BMI reduced significantly (−1.6 versus 0.7 kg, P = 0.006; −2.2 versus 1.5 cm, P = 0.0005; −0.6 versus 0.7 kg m-2, P = 0.03, respectively). QOL and depression scores also improved (−6.8 versus 1 point, P = 0.134; −0.2 versus 0.2 points, P = 0.228). No difference was observed in anxiety scores between the groups. Intervention versus control group follow-up attendance improved significantly (4.4 versus 1.7 attendances, P = 0.0005). Conclusions LEAP Beep promoted losses in weight, WC and BMI, and improved QOL parameters and follow-up attendance. Text messaging is a cheap, portable, convenient and innovative medium facilitating goal setting, self-monitoring and information exchange. Further improvements to automation at the same time as maintaining individual support are necessary to ease practitioner burden. Text messaging offers cost-efficient dietetic input, opening up possibilities for practitioner-to-patient support and yields positive weight outcomes following initial weight loss. [ABSTRACT FROM AUTHOR]

Objective This study examined autism spectrum disorder (ASD) features in relation to treatment completion and eating disorder psychopathology in anorexia nervosa (AN). Method Thirty-two adult women were recruited from specialist eating disorder services. Features of ASD and disordered eating were measured. Premature termination of treatment was recorded to explore whether ASD traits had impact on early discharge. A healthy control group was also recruited to investigate ASD traits between clinical and nonclinical samples. Results Significant differences were found between the AN group and the healthy control group in obsessive-compulsive disorder traits, depression and anxiety and ASD traits, with significant differences between groups in Social Skill and Attention Switching. The AN group reported no significant relationship between disordered eating severity and ASD traits. No significant effect was found between ASD features and treatment completion. Discussion Raw data on premature termination of treatment, despite no statistic impact, showed that seven out of the eight participants with high features of ASD completed treatment as planned compared with 50% of those with low ASD traits. Unexpectedly, this suggests enhanced treatment adherence in ASD. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Our re-analysis of census data shows that 95% of kinship arrangements are 'informal', i.e. made outside the formal child welfare system. Interviews with 80 children aged 8-18 years in informal kinship care and their carers showed that most children were well attached to their kin carers, but one-third had been taunted or bullied because they did not live with their parents. Many children tightly controlled who knew about this potentially stigmatizing information. Most children had good numbers of adults and children in their social networks, and for three-fifths, their parents were still key figures in their lives. The children who regarded few people as very important to them significantly more often lived with older kin carers (many of whom were in poor health), were more often anxious and depressed, and did not talk about their living situation to others. A considerable number of children worried about their carers' poor health and about their own future if they died. The significance of these findings for statutory and voluntary services is discussed. [ABSTRACT FROM AUTHOR]