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Purpose: Women diagnosed with non-affective psychosis have a lower general fertility rate (GFR) and age-specific fertility rate (ASFR) than women in the general population. Contemporary data on GFR in this group remain limited, despite substantive changes in prescribing and management. We calculated contemporary estimates of the GFR and ASFR for women diagnosed with non-affective psychosis compared with the general population of women without this diagnosis. Methods: A population-based design combined routinely collected historical maternity and psychiatric data from two representative areas of Scotland. Women were included from the NHS Grampian or Greater Glasgow and Clyde areas and were aged 15–44 between 2005 and 2013 inclusive. The 'exposed' group had a diagnosis of non-affective psychosis (ICD-10 F20–F29) and was compared to the general population of 'unexposed' women in the same geographical areas. Results: Annual GFR between 2005 and 2013 for women with non-affective psychosis varied from 9.6 to 21.3 live births/1000 women per year in the exposed cohort and 52.7 to 57.8 live births/1000 women per year in the unexposed cohort, a rate ratio (RR) of 0.28 [p < 0.001; 95% CI (0.24, 0.32)]. ASFR for all 5-year age groups was lower in the exposed cohort than amongst unexposed women. Conclusion: We highlight continued low fertility rates in women with a diagnosis of non-affective psychosis, despite widespread availability of prolactin-sparing atypical antipsychotics. Accurate estimation of fertility rates remains crucial in developing needs-matched perinatal care for these women. Methodological improvements using routine datasets to investigate perinatal mental health are also urgently needed. [ABSTRACT FROM AUTHOR]

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels. [ABSTRACT FROM AUTHOR]

Emotional problems in early childhood increase the risk of mental health problems into adolescence and adulthood, but the cross-cultural etiological risk factors are unclear. We examined predictors of emotional problems in preschoolers, using a national cohort of children in Chile and in Scotland. Participants included 1648 children and their families enrolled in the Chilean Encuesta Longitudinal de la Primera Infancia (ELPI) cohort and 3786 children and their families enrolled in the Growing Up in Scotland (GUS) cohort. Data were collected between 2005 and 2012. Information on emotional problems along with social and health determinants were collected via maternal reports. Emotional problems in the clinical range were identified in 10.4% of children from the ELPI cohort and in 3.6% of children from the GUS cohort. The difference between cohorts was statistically significant. Logistic regression revealed that maternal unemployment predicted emotional problems across cohorts. Lower maternal education and living in rural areas predicted higher risk of emotional problems for the ELPI cohort only, whereas having a younger mother, daily parent-child shared activities such as a lower frequency of sharing letters/shapes, and a higher exposure to television predicted higher risk for emotional problems for the GUS cohort. Maternal unemployment as a risk factor across cohorts indicates the importance of shared cross-cultural factors. However, sample specific differences highlight the importance and need for greater attention towards cultural specificities in policy and intervention development for child mental health. [ABSTRACT FROM AUTHOR]

Objectives: Research into adolescent mental health has tended to focus on primary attachment relationships. However, the effect of secondary attachment relationships and the role of culture remain under‐explored. This study examined the associations between primary attachment, secondary attachment, and coping strategies (task‐focused, emotion‐focused, and avoidant coping) with psychological well‐being and psychological distress in adolescents across two cultural settings. Design: A cross‐sectional study. Method: An identical test battery was used across two geographic sites in Pakistan (N = 510; 12–18 years; 51.5% male; mean age = 14.50) and Scotland (N = 610; 12–18 years; 53.6% male; mean age = 13.97). Associations were tested separately in each sample using moderated mediation modelling for the outcome variables: psychological well‐being and psychological distress. Results: For psychological well‐being, all three coping strategies were significant partial mediators and secondary attachment was a significant moderator in both samples. Secondary attachment moderated the association between emotion‐focused coping and psychological well‐being in the Pakistani sample only. For psychological distress, task‐focused coping was a significant full mediator in the Pakistani sample only. In contrast, for the Scottish sample, task‐focused coping and emotion‐focused coping were significant partial mediators. Secondary attachment's direct effect on psychological distress was significant in both samples. Secondary attachment also moderated the association between emotion‐focused coping and psychological distress in the Pakistani sample only. Conclusions: The cross‐cultural evidence suggests that alongside primary attachment, it is important to target secondary attachment through coping strategies, in order to enhance psychological well‐being and lessen psychological distress in adolescents. Practitioner points: Secondary attachment plays a different role from primary attachment in adolescents. Therefore, it is important to target both primary attachment and secondary attachment security to enhance psychological well‐being and lessen psychological distress.Cross‐cultural differences in coping suggest that differential strategies to target different coping dimensions may enhance adolescent well‐being across cultures.These cross‐cultural differences highlight the ethical importance of cultural sensitivity among clinicians working with adolescents globally. [ABSTRACT FROM AUTHOR]

Background: Social adversity and poor maternal mental health during pregnancy can have long-term adverse effects on the infant's health, social and educational outcomes. Stress in pregnancy may have direct physiological effects on the fetus, as well as impairing development of maternal sensitivity to the infant. Improved antenatal support and more effective engagement with 'high-risk' expectant mothers is needed. Method: Pregnant women meeting high-risk criteria were invited to participate. Participants (n=35) were randomly allocated in clusters of six to either Mellow Bumps (a 6-week antenatal parenting programme that aims to decrease maternal stress levels and emphasises the importance of early interaction in enhancing brain development and attachment), Chill-out in Pregnancy (a 6-week stress reduction programme) or care-as-usual. Results: The interventions are promising in terms of maternal mental health. Qualitative feedback suggested that the interventions' format was acceptable. A larger trial may be justified if effect sizes can be estimated with more precision. [ABSTRACT FROM AUTHOR]

Objective We aimed to develop and establish the reliability and validity of a measure of Fear of Recurrence, measuring cognitive appraisals of relapse rather than standard early signs of relapse. We also aimed to establish the sensitivity and specificity to relapse. Method Participants diagnosed with schizophrenia or a related disorder were randomized to one of two early signs monitoring conditions, using either the Early Signs Scale or the Fear of Recurrence Scale (FoRSe). Participants were followed up for 6-months or until relapse. Results A total of 169 participants were randomized to Standard ( n = 86) or Fo RSe ( n = 83) monitoring. We found good evidence supporting reliability and validity of the Fo RSe. In addition, a cut-off point of ≥5 was associated with an optimal sensitivity in both Standard ( n = 26:79%, 95% CI = 62-89) and Fo RSe ( n = 18:72%, 95% CI = 52-86) monitoring. However, this degree of sensitivity was associated with a lower specificity in Standard ( n = 30:35%, 96% CI = 23-50) and Fo RSe ( n = 25:46%, 95% CI = 32-60). Finally, Fear of Relapse was a significant predictor of time to relapse [Exp(β) = 1.20, 95% CI = 1.01-1.42, p < .05]. Conclusion The study provides evidence that Fear of Recurrence may be an important clinical construct linked to increased risk of relapse and poorer emotional recovery in people diagnosed with schizophrenia. Practitioner points Monitoring Fear of Recurrence is as sensitive to relapse detection as monitoring early signs alone., Greater Fear of Relapse was associated with shorter duration to actual relapse., Fear of recurrence may be an important clinical feature linked to poorer emotional recovery and increased risk of relapse., Fear of Recurrence may be an important focus of psychological therapy to promote emotional recovery and prevention of relapse. [ABSTRACT FROM AUTHOR]

Objectives. Although there has been increased interest in applying attachment theory to the psychological understanding of psychosis, research to date has focused on selfreported attachment and psychotic symptomatology. This study presents evidence for applying attachment and mentalization constructs to understanding engagement and adaptation to first-episode psychosis (FEP), using a narrative based interview. Design. A cross-sectional cohort design was used. Methods. Thirty-four individuals with a first episode of psychosis were interviewed using the Adult Attachment Interview. Attachment classifications and reflective function scores were derived from the interview. Psychotic symptomatology, premorbidadjustment, duration of untreated psychosis, and psychological variables were also measured. Results. Attachment distribution was heterogeneous in the sample, although the majority of participants were classified dismissing of attachment. Mentalization scores were consistent with previous clinical samples. Attachment and mentalization were unrelated to psychotic symptomatology. Conclusions. The current study demonstrates, albeit with a small clinical sample, the importance of assessing attachment and mentalization via narrative methods. The findings also have clinical implications for understanding the process of engagement and adaptation in FEP. [ABSTRACT FROM AUTHOR]

Background: There is increased interest in quality of life (QoL) as a clinically relevant factor in adjustment to, and recovery from, first-episode psychosis (FEP). Given the subjective nature of QoL, it is proposed that this variable may be associated with compromised functioning prior to the onset of psychosis, and may also have an impact on an individual's adjustment to psychosis after treatment is initiated., Aim: The current study aims to explore associations between subjective QoL, symptomatology, premorbid adjustment, duration of untreated psychosis (DUP) and engagement with services after onset of treatment., Method: A cross-sectional cohort of Scottish individuals undergoing treatment for FEP were characterized in terms of psychotic symptomatology, premorbid adjustment, DUP and service engagement. Self-reported QoL was measured using the World Health Organization Quality of Life Brief Scale, allowing for the measurement of physical, psychological, social relational and environmental aspects of QoL., Results: Higher scores for subjective QoL components were associated with better premorbid adjustment, lower positive psychotic symptoms, lower negative symptoms and less cognitive disorganization. Childhood premorbid adjustment predicted both physical and social relationship QoL., Discussion: Subjective QoL domains differ in their associations with clinical and premorbid factors. The relationship between premorbid adjustment and QoL requires further exploration in FEP., (© 2013 Wiley Publishing Asia Pty Ltd.)