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Purpose: Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g., pregnancy, menopause) and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g., trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of pre-existing mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. Methods: A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of Bias for individual studies was assessed using a modified version of the Newcastle Ottawa Scale. Results: The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for Psychotic Disorders, Panic Disorder, Eating Disorders, Depression and Borderline Personality Disorder. Less consistent evidence was found for Anxiety, and a different pattern of symptom exacerbation was observed in Bipolar Disorder. Sample size and methodology varied considerably amongst studies. Conclusion: Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.

There is currently no specific guidance addressing vaccine hesitancy in those with mental health difficulties in the United Kingdom. This is particularly problematic when one considers that individuals with serious mental illnesses are at greater risk of infection and have poorer health outcomes for a range of reasons. There are also many individual and system level barriers to vaccination in this group. When an affected adult lacks the capacity to make a decision for themselves, it often falls to healthcare professionals to make a decision on that person's behalf and in their best interests. This article explores this matter with regard to the law in practice in the English and Welsh, and Scottish, jurisdictions and consider this with relevance to the safest approach that doctors and other healthcare professionals should take in working with patients for whom mental disorder may impact on decision-making capacity. The article focuses on psychiatric inpatients, including those who are detained involuntarily, to consider whether, and in what circumstances, COVID-19 vaccination should be given to individuals who cannot or do not consent.

Purpose: There are multiple studies illustrating how benevolent childhood experiences (BCEs) are associated with more favorable health outcomes across the life-course, even in the context of adverse childhood experiences (ACEs). Despite this, few measures are available to assess BCEs. Existing measures include a narrow spectrum of objective BCEs and are limited by the use of binary response categories while few investigate BCEs specifically related to the family and home environment. Thus, the current study sought to develop and validate a measure which assesses positive recollections of experiences and emotions at home and with family during childhood called the ‘Memories of Home and Family Scale’(MHFS). Methods: Items were generated which captured a diverse range of positive emotions and experiences related to home and family life during childhood. Confirmatory factor analysis (CFA) was employed to test the latent structure of the preliminary MHFS item scores in a sample of university students from the United Kingdom (N=624). Following selection of the best-fitting model and final items for inclusion in the scale, total and subscale scores were correlated with a range of mental health outcomes. Results: The results from the CFA indicated that the latent structure of the MHFS items was best represented by a correlated six-factor first-order model. The final MHFS demonstrated high levels of internal reliability and convergent validity. Conclusion: The MHFS is a 28-item multidimensional measure which assesses positive memories of home and family during childhood across six dimensions including valued, independence, support, security, wellness, growth and meaning.

Purpose: This study represents the first assessment of the prevalence of trauma exposure, and Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), ever conducted in the general population of the Republic of Ireland. Additionally, prevalence of past-year mental health service use, comorbidity with major depression and generalized anxiety, and risk factors associated with PTSD and CPTSD were assessed. Methods: A nationally representative sample of non-institutionalized Irish adults (N = 1,020) completed self-report measures of trauma history, trauma-related psychopathology, mental health service use, and concurrent mental health problems. Results: Lifetime exposure to one or more traumatic events was 82.3%, and 67.8% reported experiencing two or more traumatic events. Males and females significantly differed in their frequency of exposure to eight of 16 traumatic events. The past-month prevalence for PTSD was 5.0% (95% CI = 3.7%, 6.3%) and 7.7% (95% CI = 6.1%, 9.4%) for CPTSD. Of those who screened positive for PTSD or CPTSD, 48.6% accessed mental health care in the past year. Comorbidity with major depression and generalized anxiety was high, especially among those with CPTSD. Several unique and shared risk factors for PTSD and CPTSD were identified. Conclusions: Approximately one-in-eight Irish adults met diagnostic requirements for PTSD or CPTSD, and comorbidity with other disorders was high. History of interpersonal trauma and exposure to multiple types of trauma in different developmental periods were associated with CPTSD. Many individuals did not access mental health care revealing a substantial mental health treatment gap.

Objective There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for International Classification of Diseases (ICD)-11 PTSD, which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an expanded trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed whether 5 psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as standard Criterion A events. Method A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results Most participants were trauma-exposed based on Criterion A (82%) and the expanded (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD, 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The 5 psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

It is clear that police in many jurisdictions are increasingly being called out to situations involving persons with mental distress. In Scotland, for example, notifications of Place of Safety Orders to the Mental Welfare Commission for Scotland increased from 130 in 2006/2007 to 1133 in 2016/2017 (Mental Welfare Commission for Scotland, 2018). Whilst this may reflect better police reporting (Mental Welfare Commission for Scotland, 2018) and these figures only account for those persons assessed in Accident and Emergency departments and not elsewhere (McGeough and Foster, 2018) this nevertheless represents a significant increase.

PurposeThe purpose of this study is to inform those who are supporting persons who are dying and are responsible for planning, commissioning or delivering palliative care about the need to support and maximise the decision-making ability and choices of persons with advanced dementia or severe frailty.Design/methodology/approachThis article will consider the legal and human rights principles applicable to Scotland, and indeed to other jurisdictions, which govern decisions about care and treatment of persons with and without capacity and the application of these principles to palliative care situations.FindingsIt is important that those involved in the care and support of the dying are fully aware of the need to support and maximise their decision-making ability concerning palliative care and treatment choices.Research limitations/implicationsIt is a well-established legal and human rights principle that the decisions of a person with capacity must be respected, including decisions about palliative care and treatment at the end of life. Moreover, recent developments in international human rights law reinforce the message that this principle applies equally to all. Applying this principle into persons with advanced dementia or severe frailty therefore requires skilled assessment and supported decision-making in order to optimise capacity and respect autonomy.Originality/valueThe discussion applies the United Nations Convention on the Rights of Persons with Disabilities approach concerning equality of rights enjoyment and supported decision-making to palliative care and treatment situations.

BackgroundDimensional models of psychopathology are increasingly common and there is evidence for the existence of a general dimension of psychopathology (‘p’). The existing literature presents two ways to model p: as a bifactor or as a higher-order dimension. Bifactor models typically fit sample data better than higher-order models, and are often selected as better fitting alternatives but there are reasons to be cautious of such an approach to model selection. In this study the bifactor and higher-order models of p were compared in relation to associations with established risk variables for mental illness.MethodsA trauma exposed community sample from the United Kingdom (N = 1051) completed self-report measures of 49 symptoms of psychopathology.ResultsA higher-order model with four first-order dimensions (Fear, Distress, Externalising and Thought Disorder) and a higher-order p dimension provided satisfactory model fit, and a bifactor representation provided superior model fit. Bifactor p and higher-order p were highly correlated (r = 0.97) indicating that both parametrisations produce near equivalent general dimensions of psychopathology. Latent variable models including predictor variables showed that the risk variables explained more variance in higher-order p than bifactor p. The higher-order model produced more interpretable associations for the first-order/specific dimensions compared to the bifactor model.ConclusionsThe higher-order representation of p, as described in the Hierarchical Taxonomy of Psychopathology, appears to be a more appropriate way to conceptualise the general dimension of psychopathology than the bifactor approach. The research and clinical implications of these discrepant ways of modelling p are discussed.

Complex posttraumatic stress disorder (CPTSD) has been included as a diagnostic category in the International Classification of Diseases, 11th Edition, consisting of six symptom clusters: the three PTSD criteria of reexperiencing, avoidance, and hypervigilance, in addition to three disturbances of self-organization (DSO) symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept. As borderline personality disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD. This article aimed to identify groups with distinct profiles of self-reported CPTSD and BPD symptoms and associated trauma history characteristics. A latent class analysis (LCA) using CPTSD and BPD symptom variables was conducted on a sample of 195 treatment-seeking adults at a specialist trauma service. The classes were then compared on demographic and clinical characteristics using a series of analysis of variance and χ2 tests. The latent class analysis determined three distinct classes: a CPTSD/High BPD class characterized by high symptom endorsement across both conditions, a CPTSD/Moderate BPD class characterized by high PTSD and DSO symptom endorsement and moderate BPD, and a PTSD/Low BPD class characterized by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment. Findings support the construct of a CPTSD diagnosis as a separate entity although BPD features seem to overlap greatly with CPTSD symptoms in this highly traumatized clinical sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This paper serves to alert IJPDS readers to the availability of a major new longitudinal survey data resource, the COVID-19 Psychological Research Consortium (C19PRC) Study, which is being released for secondary use via the Open Science Framework. The C19PRC Study is a rich and detailed dataset that provides a convenient and valuable foundation from which to study the social, political, and health status of European adults during an unprecedented time of change as a direct result of the COVID-19 pandemic and Brexit. Here, we provide an overview of the C19PRC Study design, with the purpose of stimulating interest about the study among social scientists and maximising use of this resource.

Background Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia. Methods Our sample included all reported live singleton births in Victoria 2009–2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness. Results Of all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37–2.43), having gestational diabetes mellitus (1.57, 1.34–1.84), undergoing an unplanned caesarean section (1.17, 1.02–1.33), induction of labour (1.17, 1.05–1.30) and postpartum haemorrhage (1.15, 1.03–1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43–1.80), a low Apgar score at 5 minutes (1.50, 1.19–1.90), preterm birth (1.40, 1.20–1.63), and low birthweight (1.26, 1.06–1.49). Conclusion Women with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.

Background The new International Classification of Diseases was published in 2018 (ICD-11; World Health Organization, 2018) and now includes 'Mixed depressive and anxiety disorder' (6A73: MDAD) designated as a mood disorder. This disorder is defined by symptoms of both anxiety and depression occurring more days than not, for a period of two weeks, and neither set of symptoms considered separately reaches a diagnostic threshold for either disorder. However, to date no study has examined the validity of these guidelines in a general population sample. Methods Using Goldberg et al.'s (2017) guidelines regarding measurement of depression and anxiety, this study used factor mixture modelling (FMM) to examine the validity of the ICD-11 criteria of MDAD. Symptom endorsement rates are provided as well as demographic predictors and somatization outcomes. Results Fit indices suggested the two-factor four-class solution was the best balance between model complexity and model fit. The results did not support a class that is subsyndromal to both anxiety and depression. On the contrary, we suggest that there exists a 'Comorbid' class that represents endorsement of both anxiety and depression symptoms at a higher level when compared to both 'anxiety' and 'depression' groups. Demographic predictors, as well as somatization and functional impairment outcomes, provided support for this FMM solution. Conclusions The 'Comorbid' group was the largest symptomatic group and had the highest levels of both anxiety and depression symptoms. Importantly, this group was larger than either the 'anxiety' or 'depression' group and was associated with high levels of functional impairment and somatization.

Background Smoking poses a serious risk of early preventable death and disease especially for women living with socio-economic disadvantage (SED). A smoking cessation programme, ‘We Can Quit’, was developed in Ireland tailored to SED women. This includes group-based support delivered by trained lay local community facilitators (CFs) and free nicotine replacement therapy (NRT). The intervention was pilot tested in a cluster randomised controlled trial, ‘We Can Quit 2’. This paper reports on the WCQ2 process evaluation which assessed feasibility and acceptability of the programme and trial processes. Methods Embedded qualitative design using the UK Medical Research Council’s process evaluation framework. Semi-structured interviews with trial participants (N = 21) and CFs (N = 8). Thematic analysis was utilised. Results Peer-modelling, a non-judgemental environment, CFs facilitation of group support were viewed as acceptable programme related factors. Some participants expressed concerns about NRT side effects. Provision of free NRT was welcomed and accepted by participants, although structural barriers made access challenging. Pharmacists took on a role that became larger than originally envisaged – and the majority provided additional support to women in their quit attempts between group meetings which augmented and supplemented the intervention sessions provided by the CFs. Participants reported good acceptance of repeated measures for data collection, but mixed acceptability of provision of saliva samples. Low literacy affected the feasibility of some women to fully engage with programme and trial-related materials. This was despite efforts made by intervention developers and the trial team to make materials (e.g., participant intervention booklet; consent forms and participant information leaflets) accessible while also meeting requirements under 2018 European General Data Protection Regulation legislation. Hypothetical scenarios of direct (e.g., researcher present during programme delivery) and indirect (e.g., audio recordings of programme sessions) observational fidelity assessments for a future definitive trial (DT) were acceptable. Conclusions Intervention and trial-related processes were generally feasible and acceptable to participants and CFs. Any future DT will need to take further steps to mitigate structural barriers to accessing free NRT; and the established problem of low literacy and low educational attainment in SED areas, while continuing to comply within the contemporary legislative research environment. Trial registration WCQ2 pilot trial (ISRCTN74721694).

Objective: Emerging evidence indicates that the mental health consequences of COVID-19 may not be as deleterious as initially feared. We analyzed the levels of symptom expression and rates of Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and COVID-19 related Posttraumatic Stress Disorder (C19-PTSD) in the adult population of Ireland at different points during the first year of the pandemic.Methods: Data were collected from a nationally representative sample of 1041 adults across five waves from March/April 2020 to March/April 2021. New participants were recruited at follow-up waves to maintain nationally representative cross-sectional estimates. Cross-sectional estimates of each and any disorder were calculated, and longitudinal changes in means and prevalence estimates of MDD, GAD, and C19-PTSD were assessed using structural equation modelling.Results: Cross-sectional estimates of meeting criteria for MDD, GAD, or C19-PTSD were 34.7% in March/April 2020 (Wave 1) and 33.7% in March/April 2021 (Wave 5). Longitudinal analyses revealed no significant change in symptoms of MDD, a significant decrease in GAD symptoms, and a significant increase in C19-PTSD symptoms. There were significant decreases in prevalence estimates of MDD (by 4.9%) and GAD (by 6.3%), and no significant change in C19-PTSD. Overall, 4.7% fewer people met criteria for any disorder at Wave 5 than at Wave 1. Conclusion: There was no evidence of an increase in mental health problems in the adult population during the first year of the pandemic in Ireland. Analyses of longitudinal data indicated a small but significant decrease in the proportion of people suffering from a mental health disorder.

Introduction Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness. Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. Methods This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. Results ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. Conclusion There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. Key words Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol

Research and theory suggest that desistance narratives and pro-social identities are key to the process of desistance from crime. However, little research has examined how desistance narratives and related identities are produced in contexts other than research interviews or how core correctional skills intersect with the development of these narratives or identities. This study applies discourse analysis and conversation analysis to transcripts of 12 video-recordings of groupwork sessions for addressing sexual offending, examining how desistance narratives and identities are produced, and how practitioner skills and conversational styles intersect with their production. The analysis illustrates how criminal justice practitioners help to co-author desistance narratives through subtle and explicit aspects of interaction, although certain orientations to risk may limit this potential.

Objective: There is growing global evidence for stark inequalities in the physical health status and life-expectancy of people with a mental health diagnosis. In most cases, physical activity (PA) is one of the most effective methods of maintaining physical and mental health. However, people with mental health challenges are less likely to adhere to recommended levels of PA, leading to a vicious cycle of poor physical and mental health. The objective of this paper is to assess if, and how cognitive-behavioural (CB) techniques increase adherence to PA in mental health populations.Method: Systematic review and narrative synthesis. Included studies detailed a behavioural change intervention which targeted PA using CB approaches, delivered to adults with a mental health condition as defined by DSM V or ICD-10. Adherence to the intervention AND physical activity was reported within RCT, cluster RCT, quasi-experimental, or controlled before and after study. Electronic searches conducted in MEDLINE, CINAHL, Cochrane Library (Trials), SPORTDiscus and PsycINFO. Results: Ten studies from seven countries were synthesised. Methodologically moderate to weak, all showed adherence to the intervention to be associated with increased levels of PA. All studies reported higher than average adherence to PA in the intervention groups.Discussion: CB interventions were associated with improved adherence to PA in international samples of people with mental health conditions. Studies adopting more robust designs are needed to quantify optimal interventions and impact, but this original synthesis is encouraging for researchers and clinicians alike looking to maximise the synergy between physical and mental health.

The Adjustment Disorder – New Module 20 (ADNM-20) was developed for the assessment of adjustment disorder symptoms. The aim of the present study was to translate and conduct psychometric testing of the Chinese version of the ADNM-20. The English version was translated into traditional Chinese in an iterative process with an expert panel of mental health professionals. A total of 433 university students in Hong Kong between ages 18–24 years completed the Chinese ADNM-20 and the Hospital Anxiety and Depression Scale via an online survey; 32 were retested after two weeks. The content validity indices were excellent for most of the items. Confirmatory factor analysis supported a unidimensional first-order structure with excellent composite reliability. The test–retest reliability of the Chinese version was below satisfactory for the individual items; the intra-class correlation for the overall scale was moderate. The Chinese version of the ADNM-20 also indicated a moderate positive correlation with anxiety and depression symptoms. Initial results support the content, factorial, and discriminant validity of the translated scale. More research is needed to assess its reliability in this cultural context. The ADNM-20 can be quickly employed for the assessment of adjustment disorder as proposed for ICD-11.

Debate exists in the trauma literature regarding the role of dissociation in traumatic stress disorders. With the release of the new ICD-11 diagnostic guideline for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), this issue warrants further attention. In the current study, we provide a preliminary assessment of the associations between ICD-11 CPTSD and dissociative experiences. This study is based on a sample (N = 106) of highly traumatised clinical patients from the United Kingdom who completed measures of traumatic stress and dissociative experiences. The majority of participants met the diagnostic criteria for CPTSD (69.1%, n = 67), with few patients qualifying for a diagnosis of PTSD (9.3%, n = 9). Those with CPTSD had significantly higher levels of dissociative experiences compared to those with PTSD (Cohen’s d = 1.04) and those with no diagnosis (Cohen’s d = 1.44). Three CPTSD symptom clusters were multivariately associated with dissociation: Affective Dysregulation (β = .33), Re-experiencing in the here and now (β = .24), and Disturbed Relationships (β = .22). These findings indicate that dissociative experiences are particularly relevant for clinical patients with CPTSD. Future longitudinal work will be needed to determine if dissociation is a risk factor for, or outcome of, CPTSD.

Background: Co-occurrence of psychosis and posttraumatic stress disorder (PTSD) symptoms has been demonstrated, but the ICD-11 marks a significant divergence in the formulation of PTSD with a focus on the core symptoms and the addition of complex PTSD (CPTSD). Objective: To evaluate the distribution of psychosis and traumatic stress symptoms using the ICD-11 conceptualisation of PTSD and CPTSD. Method: A latent class analysis was conducted on psychosis symptoms, PTSD and CPTSD among a random adult sample from the UK general population with a history of traumatic events (N = 1,051). Results: Six classes were identified; a low-symptom class, a PTSD-class, a CPTSD-class, a class characterized by disturbances in self-organization alone as well as two classes characterized by CPTSD and various levels of psychosis symptom endorsement. Cumulative childhood adversity predicted membership of the PTSD, CPTSD and comorbid classes in a dose-response manner with the strongest effects observed for classes characterised by comorbid symptoms. Conclusion: The present study confirms the co-occurrence of psychosis symptoms and ICD-11 PTSD and CPTSD. Psychosis symptoms did not emerge in isolation from traumatic stress symptoms, underpinning the need for a greater recognition of psychosis symptoms as part of the broader clinical picture among trauma-exposed populations.

Background: Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. Methods: An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. Results: Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p

Chaplains’ unique contribution is to healthcare is to respond to the spiritual, religious and pastoral needs of patients and staff. This is their sole purpose, to provide a presence and space to meet individual need and promote healing, even when cure isn’t possible. Their value is priceless to families in desperate times. However, despite growing evidence for their impact, chaplains are commonly undervalued and misunderstood by their organisations, and the global pandemic revealed the consequences of this confusion. Whilst some chaplains were applauded as heroes along with their fellow health colleagues, others were seen as little more than an infection risk. A survey was designed to capture and learn from the full range of chaplain experiences of the impact of the pandemic across the globe. In June 2020, 1657 chaplains responded from 36 countries. They all experienced considerable disruption to their usual practice, with enforced social distancing having the biggest impact. Out of necessity they embraced technology to maintain contact with patients and families, and shifted focus of their support to staff. Whilst some chaplains were viewed as essential employees by their organisations, most were not. Despite the majority thinking that their organisations understood what they did, chaplains themselves were neither clear or unclear about their role during and post pandemic. More surprisingly, they felt similarly unclear about their role before the pandemic. This paper concludes that in general chaplains lack leadership skills, and confusion about their role will persist until this changes.

Article 12(3) CRPD requires states parties to provide access by persons with disabilities to the support they may require in exercising their legal capacity. This is to ensure that the rights, will and preferences of persons with disabilities are enjoyed on an equal basis with others [Articles 12(1)(2) and (4) CRPD]. Moreover, the Committee on the Rights of Persons with Disabilities has made it clear that supported decision-making must replace substitute decision-making arrangements as these are discriminatory and deny equal enjoyment of the right to exercise of legal capacity for persons. At the same time, there is ongoing debate as to whether or not the absence of substitute decision-making regimes is essential for the non-discriminatory realization of an individual's rights, will and preferences to be achieved. To resolve this debate, however, specific attention needs to be paid to the CRPD message on what it actually means to give effect to the equal and non-discriminatory enjoyment of rights for all. In the context of persons with mental disabilities this requires looking beyond human rights simply in terms of limiting unwarranted interventions to the proactive removal of obstacles to full rights enjoyment and the creation of environments that respect and support such enjoyment. With this in mind this paper will therefore critically consider the use of supported decision-making within existing substitute decision-making regimes with particular reference to Scotland's mental health and capacity laws. It will consider the challenges this poses and whether it is indeed possible to adapt existing regimes to achieve CRPD compliance. In doing so, it is suggested that a full appreciation of the overarching CRPD message about equality and non-discrimination in the enjoyment of rights is required to bring about such compliance.

Background Existing research on post-traumatic sequelae suggests a positive association between fatalism and symptoms of post-traumatic stress disorder (PTSD). However, the associations between fatalism and the new ICD-11 diagnosis of complex PTSD (CPTSD) have never been explored before. Objective The current study explored the association between fatalism and PTSD and CPTSD in samples from three African countries. Methods A total of 2,524 participants from Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500) completed measures of fatalism (non-judgemental fatalism, current fatalism, pessimistic fatalism, prospective fatalism) and the International Trauma Questionnaire (ITQ). A combination of a multinomial regression and path analysis was used to identify fatalism predictors of PTSD and CPTSD versus no diagnosis, and CPTSD versus PTSD, adjusted for demographic variables and trauma exposure. Results While PTSD was not predicted by any of the fatalism types, compared to no diagnosis, CPTSD was significantly predicted by pessimistic, non-judgemental and current fatalism, both compared to no diagnosis and PTSD. Conclusions The results broaden the knowledge on potential correlates of the new diagnosis of CPTSD. Addressing fatalistic beliefs by empowering people to think that they can choose their fate should be further explored as a possible target for intervention in the treatment of CPTSD., HIGHLIGHTS The study explored the association between fatalism and PTSD and CPTSD according to ICD-11 definition in samples from three African countries.The results broaden the knowledge beyond Western population on potential correlates of the new diagnosis of CPTSD.

Objectives: As working lives extend and there is better recognition of early-onset dementias, employers need to consider dementia as a workplace concern. With suitable support, people living with dementia can continue employment–although, this is not appropriate for all. The requirement for employers to support employees living with dementia has human rights and legal foundations. This article considers whether employers consider dementia as a workplace concern; and the policies and/or practices available to support employees living with dementia. Thus, it develops understanding of whether employers are meeting their human rights/legislative obligations. Method: A sequential mixed-methods approach was employed, with data collection undertaken in Scotland (United Kingdom). An online survey was sent to employers across Scotland, with 331 participating. Thirty employer interviews were conducted, with the survey results informing the interview approach. Results: The survey and interview data were analyzed separately and then combined and presented thematically. The themes identified were (1) Dementia as a workplace concern, (2) Support for employees living with dementia and (3) Employer policy development and awareness raising. The findings demonstrate dementia awareness, but this knowledge is not applied to employment situations. There was little evidence suggesting that the rights of employees living with dementia are consistently upheld. Conclusion: This research sends out strong messages about the rights and legal position of person living with dementia which cannot be ignored. The continuing potential of employees living with dementia and their legal rights are not consistently recognized. This highlights the need for robust training interventions for employers.

Background Numerous studies found robust associations between psychosis and posttraumatic stress disorder (PTSD), but few have examined the relationships between psychosis and recently formulated ICD-11 Complex PTSD (CPTSD). Further, no known study has examined the effects of different traumatic life events on CPTSD and psychotic-like symptoms in a manner that permits gender-specific effects to be identified. Objective Using a nationally representative sample of 1,020 Irish adults, we examined gender-differences in (a) psychotic-like symptoms, CPTSD, and exposure to 21 different traumatic life events, and (b) the unique associations between different traumas with CPTSD and Psychosis. Method Bivariate analyses and structural equation modelling were performed. Results Consistent with the literature, no gender differences were observed in psychotic-like symptoms. Females reported slightly higher levels of CPTSD and were more likely to be exposed to sexual and emotional abuse, whereas men reported greater exposure to physical violence, accidents, and disasters. Psychosis symptoms were explained by trauma exposure to a considerate degree and at a level similar to CPTSD; a moderate correlation was also found between CPTSD and Psychosis. Physical/emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions. Two gender-specific associations between different traumatic life events and CPTSD and Psychosis were identified out of the 42 possible effects modelled. Conclusions The present investigation provides initial evidence that psychotic-like symptoms and CPTSD are moderately correlated constructs in the general population. Results also highlight the importance of conducting a detailed assessment of trauma history for all clients presenting with symptoms of CPTSD, psychosis, or both., HIGHLIGHTS Structural equation modelling of data from 1,020 Irish adults showed symptoms of psychosis and complex posttraumatic stress disorder moderately correlate.Physical emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions.

Background: The Global Forum for Health Research, with the support of the World Health Organization, highlighted the need to prioritize mental health research in Africa. The introduction of revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder, along with new diagnoses of Complex PTSD and Prolonged Grief Disorder, in the ICD-11 creates a need for additional national-level epidemiological studies on the prevalence of stress-related disorders. Methods: The prevalence rates of these four ICD-11 stress disorders were assessed in three African countries including Nigeria (N = 1006), Kenya (N = 1018), and Ghana (N = 500). Participants completed disorder-specific measures for each disorder. Findings: Across the entire sample, the current prevalence rate of probable Adjustment Disorder was 8.4% (95% C.I. = 7.4%, 9.6%), probable PTSD was 18.6% (95% C.I. = 17.2, 20.2%), probable Complex PTSD was 15.9% (95% C.I. = 14.5%, 17.4%) and probable Prolonged Grief Disorder was 3.7% (95% C.I. = 3.1%, 4.5%). Interpretation: The results are applicable primarily to well-educated urban and suburban adults in these African countries. Results indicated that Adjustment Disorder, PTSD, and CPTSD are highly prevalent in these three African countries. There is now a pressing need to develop culturally sensitive interventions to enable recovery from these conditions.

Exposure to traumatic events has been associated with negative psychological outcomes. There is, however, a dearth of research on revictimization (i.e., experiences of victimization during both childhood and adulthood). The current study examined different patterns of lifetime interpersonal victimization based on six types of childhood maltreatment, physical and sexual assault, and assault with a weapon during adulthood via latent class analysis (LCA) with gender as covariate. Using a 3-step approach the study assessed differences across the latent classes in symptoms and diagnosis of depression, anxiety, and DSM-5 posttraumatic stress disorder. An adult sample representative of the United Kingdom population with exposure to trauma (N = 1,051) was recruited online through a research panel. Mean age of the sample was 47.18 years (SD = 15.00, range = 18-90 years; 68.4% female). LCA identified five classes, namely, lifetime polyvictimization (8.3%; 69.5% female), sexual revictimization (13.7%; 96.5% female), physical revictimization (12.5%; 1.5% male), childhood trauma (25.9%; 85.6% female), and limited victimization (39.7%; 40.3% female). The revictimization class had elevated scores in anxiety, depression, and posttraumatic stress symptoms, followed by the childhood trauma class compared to the other classes. The polyvictimization class had nearly a 9 to 33-fold increase in risk of a diagnosis of depression, anxiety and PTSD, compared to the limited victimization class. Findings facilitate the identification of individuals at risk for revictimization and indicate that evidence-based clinical interventions should be targeted towards those with exposure to revictimization and childhood trauma to alleviate symptoms of posttraumatic stress, depression, and anxiety.

Background: Both BPD and PTSD are associated with exposure to traumatic events and are highly comorbid. No review to date has addressed the clinical presentations and traumatic backgrounds associated with these disorders although this work is essential for the development of effective interventions.Objectives: To systematically explore similarities and differences in traumatic history and clinical presentation in comorbid BPD and PTSD as compared to PTSD or BPD alone.Method: The Web of Science, Cochrane Library, PsychInfo, Medline, and PILOTS databases were searched systematically. Eligible studies included adult populations, compared comorbid BPD/PTSD to a single disorder, and published in English.Results: 10,147 cases across 33 studies were included; 2057 comorbid BPD/PTSD, 2648 BPD only, and 5442 PTSD only. The comorbid group overall reported greater exposure to multiple and interpersonal trauma and elevated emotion dysregulation compared to both single disorder groups. In terms of methodological quality, most papers achieved a Fair rating with improvements required in minimising bias through recruiting adequate and representative samples, and reporting on traumatic exposure.Conclusion: Multiple and interpersonal trauma might have a unique role in the development of comorbid BPD/PTSD features, particularly so for emotion dysregulation. Future research is required to unravel the unique characteristics of interpersonal trauma that can generate BPD and PTSD symptoms.Practitioner Points• Practitioners should routinely assess for interpersonal trauma considering its impact• Tackling emotional regulation difficulties might promote recovery from both PTSD and BPD symptoms• Presence of self-injury might be used to discriminate between PTSD and BPD and offer suitable interventions

Although psychoeducational interventions are recommended as phase 1 interventions for complex trauma there is limited evidence on their efficacy. This pilot randomised control trial (RCT) investigated the efficacy of a pure psychoeducational intervention for complex trauma. A brief 10 session intervention was delivered to n=44 female prisoners in a compressed format to accommodate short sentence lengths and was compared to usual care (n=42). Results from an intent‐to‐treat (ITT) analysis indicated that there were no statistically significant differences between the two arms across the three assessment time points (including one month post intervention) for the main outcomes (Behavioural Assessment Checklist‐Revised, β= 4.60 [95%CI, ‐1.60 to 10.88], p= .148; PTSD Checklist, β= ‐1.47 [95%CI, ‐4.30 to 1.36], p= .303). Post hoc Reliable Change analyses suggested twice the number of AD participants made progress in addressing PTSD symptoms compared to usual care (30.3% vs 17.6%, OR 2.03 [95%CI, .64 to 6.43]). Whilst further work in this area is required, initial results, overall, suggest that psychoeducational group based treatment modalities achieve only small effect sizes in comparison to usual care.

Codependency is a complex and debatable concept, which has been used over the years by mental health professionals to inform their practices. Researchers have attempted to identify the main problems associated with codependency; however, their evidence is still inconclusive. This is the first time that interpretative phenomenological analysis (IPA) has been used to explore the lived experience of codependency from the perspective of self-identified codependents. Eight participants recruited from local support groups for codependency in the UK, offered in-depth information about their subjective experiences, and embedded in their lifeworld. Data was gathered through interviews and a visual method. The shared experience of codependency was portrayed by the participants as a complex but tangible multidimensional psychosocial problem in their lives. It incorporated three interlinked experiences: a lack of clear sense of self, an enduring pattern of extreme, emotional, relational, and occupational imbalance, and an attribution of current problems in terms of parental abandonment and control in childhood.

I.ROC is a brief tool measuring personal recovery designed for collaborative use within support. This study aimed to investigate the psychometric properties of a self-report version of the I.ROC within a trauma population. A total of 107 adults attending trauma interventions in an NHS service in Scotland completed I.ROC alongside measures of self-esteem, mental illness symptoms and functional impairment. Scores on each measure were compared to evaluate the convergent validity of I.ROC. Internal consistency and factor analytical techniques were also used to assess the structural validity and reliability of the measure. Results of internal consistency, convergent validity and factor analysis provide preliminary support for I.ROC’s validity within a trauma population Previously proposed models were a poor fit for the current sample; principal components analysis suggested a three-factor structure with acceptable internal consistency, comprising ten of the original twelve items (I.ROC-10). Correlations with all measures reached significance for the original and modified I.ROC and its subscales. I.ROC appears to be a valid and reliable tool for use in measuring recovery within a trauma population, but further research is needed to examine the structural validity of I.ROC.

Background: Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. Methods: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. Results: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. Discussion: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.

Background: Veterans with PTSD typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and Complex PTSD (CPTSD) has not previously been explored in a military sample.Aim: This study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire (ITQ), and assess the rates of the disorder in a sample of treatment-seeking UK veterans.Method: A sample of help-seeking veterans (n=177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.Results: The majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.Conclusions: ITQ can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.

Objectives: Existing qualitative studies focussed predominantly on exploring immigrants’ stress, distress and coping aimed at reducing stress. Little attention has been paid to immigrants’ psychological growth or positive life changes. In the present study the impact of post-migration experiences on well-being among economic immigrants has been explored. Design: Semi-structured interviews were conducted with a sample of 17 immigrants. Transcripts were analysed by a deductive and inductive thematic analysis. Results: All immigrants reported positive life changes as a result of migration. Experiences related to migration helped immigrants rebuild their sense of self-worth and find ‘mental peace’ after living a demanding and burdensome life in Poland. Immigrants’ accounts also suggested that their thinking and behaviour patterns may be shaped by their cultural values and socio-economic background. Conclusion: Overall, the study indicates that migration is not merely a stressful life event but can have a positive impact on many aspects of immigrants’ lives and may provide opportunities for personal growth

The current study investigated the mediating role of Early Maladaptive Schemas (EMS) in the association between childhood trauma and Complex PTSD (CPTSD) symptom severity in a clinical sample of 42 older adults (>64 years). It was found that EMS total score mediated the relationship between childhood trauma and CPTSD symptom severity. Two second order schema factors (Disconnection; Impaired Autonomy) also had a mediating role in this relationship. Results provide preliminary support for the utility of interventions targeting EMS, particularly in the domains of Disconnection and Impaired Autonomy, in order to alleviate CPTSD symptoms. Future research is required to replicate these results within larger samples and to examine the efficacy of schema and cognitive interventions within trauma exposed older adults.

Background There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. Objectives We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. Methods Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. Results Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. Conclusions Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.

BACKGROUND: Evidence-based psychological interventions to support treatment decision-making capacity (capacity) in psychosis do not currently exist. This study sought to establish whether reducing the extent to which this group form conclusions based on limited evidence, also known as the "jumping-to-conclusions" (JTC) bias, could improve capacity. METHODS: In a randomized controlled open trial, 37 patients aged 16-65 years diagnosed with schizophrenia-spectrum disorders were randomly assigned (1:1) to receive a single-session intervention designed to reduce the JTC bias (MCT-JTC; adapted from Metacognitive Training [MCT]) or an attention control (AC) condition designed to control for therapist attention, duration, modality, and face validity. Primary outcomes were treatment decision-making capacity measured by the MacArthur Competency Assessment Tool for Treatment (MacCAT-T) and the jumping-to-conclusions reasoning bias measured by draws to decision on the beads task, each of which were administered by the psychologist delivering the intervention. RESULTS: Those receiving MCT-JTC had large improvements in overall capacity (d = 0.96, P < .05) and appreciation (d = 0.87, P < .05) compared to those receiving AC. Reduction in JTC mediated a large proportion of the effect of group allocation on understanding, appreciation, reasoning, and overall MacCAT-T scores. CONCLUSION: This is the first experimental investigation of the effect of a psychological intervention on treatment decision-making capacity in psychosis. It provides early evidence that reducing the JTC bias is associated with large and rapid improvements in capacity. Due to limited resources, assessments were administered by the researchers delivering the intervention. Results should therefore be considered preliminary and a larger, definitive trial addressing methodological limitations is warranted.

ICD-11 complex PTSD (CPTSD) is a new condition and therefore there are as yet no clinical trials evaluating interventions for its treatment. In this paper, we provide the rationale for a flexible multi-modular approach to the treatment of CPTSD, its feasibility and some evidence suggesting its potential benefits. The approach highlights flexibility in the selection of empirically-supported interventions (or set of interventions) and the order of delivery based on symptoms that are impairing, severe and of relevance to the patient. The approach has many potential benefits. It can incorporate the use of interventions for which there is already evidence of efficacy allowing the leveraging of past scientific efforts. It is also consistent with patient-centered care which highlights the importance of patient choice in identification of the problems to target, interventions to select and outcomes to monitor. Research on modular treatments with other disorders has found that compared to disorder-specific manualized protocols, flexible multi-modular treatment programs are superior in resolving identified problems and are associated with greater therapist and reduced patient burden. We briefly identify types of interventions that have been successful in treating trauma-exposed populations along with emerging interventions that are relevant to the particular problems associated with exposure to complex trauma and conclude with examples of how such treatments can be organized and tested. Research is now urgently needed on the effectiveness of existing and new intervention approaches to ICD-11 CPTSD treatment.

The inclusion of complex posttraumatic stress disorder (CPTSD) in the 11th revision of the International Classification of Diseases is an important development in the field of psychotraumatology. Complex PTSD was developed as a response to a clinical need to describe difficulties commonly associated with exposure to traumatic stressors that are predominantly of an interpersonal nature. With this special section, we bring attention to this common condition following exposure to traumatic stressors that only recently has been designated an official diagnosis. In this introduction, we review the history of CPTSD as a new condition and we briefly introduce the papers for the special section in the present issue of the Journal of Traumatic Stress. It is our hope that the work presented in the special section will add to an ever‐expanding evidence base. We also hope that this work inspires further research on the cultural validity of CPTSD, its assessment, and treatment.

Background Tobacco use is the leading cause of preventable death in Ireland with almost 6000 smokers dying each year from smoking-related diseases. The ‘We Can Quit2’ (WCQ2) study is a pilot pragmatic two-arm, parallel-group, cluster randomised trial that aims to explore the feasibility and acceptability of trial processes including recruitment and to estimate parameters to inform sample size estimates needed for an effectiveness trial. This future trial will assess the effectiveness of a community-based smoking cessation intervention for women living in disadvantaged areas on short- and medium-term cessation rates. Methods/design Four matched pairs of districts (eight clusters) selected by area level of deprivation, geographical proximity, and eligibility for free medical services will be randomised to receive either WCQ (behavioural support + access to Nicotine Replacement Therapy (NRT)) delivered over 12 weeks by trained Community Facilitators (CFs) or to a form of usual care, a one-to-one smoking cessation service delivered by Smoking Cessation Officers from Ireland’s national health service, the Health Service Executive (HSE). Within each cluster, 24–25 women will be recruited (97 per arm; 194 in total) in 4 phases with consent obtained prior to cluster randomisation. The outcome measures will assess feasibility and acceptability of trial processes, including randomisation. Outcome data for a future definitive intervention (biochemically validated smoking abstinence) will be collected at end of programme (12 weeks) and at 6 months. WCQ2 has an embedded process evaluation using both qualitative and quantitative methods. This will be conducted (semi-structured client and CF interviews, intervention delivery checklist, and diary) to explore acceptability of trial processes, intervention fidelity, trial context, and implementation. Trial processes will be assessed against domains of the PRECIS-2 wheel to inform a future definitive trial design. Discussion Data from this pilot trial will inform the design and sample size for a full cluster randomised trial to determine the effectiveness of an intervention tailored to disadvantaged women in improving smoking cessation rates. It will provide transferable learning on the systems and implementation strategies needed to support effective design of future pragmatic community-based trials which address health promotion interventions for women in disadvantaged communities. Trial registration Concurrent to publication. Controlled trials ISRCTN74721694.

The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment‐based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover.

Background Annual reviews of people living with long-term conditions (LTCs) are mostly conducted by practice nurses (PNs), who focus on the physical needs of patients. The broader mental well-being and social needs of patients are also important if they are to live well. The Patient Centred Assessment Method (PCAM) is a new tool to help PNs conduct biopsychosocial assessments of patients’ needs. Research questions Is it feasible and acceptable to use the PCAM in primary care nurse-led reviews for those with LTCs? Is it feasible and acceptable to run a cluster randomised trial of the PCAM in primary care? Methods Four practitioner and two patient focus groups explored the acceptability and implementation requirements of the PCAM, which was then tested in a feasibility cluster randomised controlled trial aiming to recruit eight general practitioner (GP) practices and 16 nurses. Baseline data collection was conducted with nurses prior to randomisation, with a cohort of 10 patients per nurse, including patient demographics, patient evaluation of consultation, patient-completed outcomes (measured via the Consultation and Relational Empathy, Patient Enablement Instrument, Warwick–Edinburgh Mental Well-Being Scale, General Health Questionnaire and the Short Form questionnaire-12 items) and nurse referrals/signposting to services. Patient follow-up questionnaires were completed at 8 weeks. Practices were then randomised to the PCAM intervention or care as usual (CAU). Data collection was repeated for a second cohort of patients. Fidelity was tested by comparing a sample of recorded consultations before and after PCAM training. Qualitative interviews were conducted with PCAM nurses and a sample of patients. Results Approaches to 159 eligible practices resulted in the recruitment of six practices (10 nurses), with five practices (seven nurses) completing both data collection phases. Nurses collected baseline data on 113 patients, 71 of whom (62.8%) completed follow-up questionnaires. Five practices were randomised: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the CAU arm. In phase 2, seven nurses collected data on 77 patients, of whom 40 (52%) completed follow-up. Only four PCAM nurses agreed to recording consultations, with five pre- and four post-PCAM recordings obtained. Post PCAM training, there was evidence of more attention being given to patients’ mental well-being and social issues. The PCAM was fairly easily integrated into consultation, although some nurses reflected that this benefited from early support. Patients were not always aware of its use, but most were happy to have their needs assessed. Limitations Recruitment of GP practices, and nurse recruitment and retention. Conclusions The PCAM is feasible and acceptable for use by primary care nurses and may have potential for encouraging biopsychosocial assessment of patients. Efforts required to recruit and retain staff indicate that a full trial is not feasible or cost-effective at this time. Future work The PCAM intervention warrants further exploration as an effective mechanism for improving care for people with LTCs; this could be conducted within an implementation study. Trial registration Current Controlled Trials ISRCTN98973169. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 6, No. 4. See the NIHR Journals Library website for further project information.

The right to health has been somewhat neglected in discussions about human rights at both national and international levels. States are often reluctant to implement socio-economic rights which they consider to be a resourcing issue, rather than a matter of rights. The right to mental health has received even less attention and is rarely mentioned in national laws and policies, with the focus remaining largely on compulsory care and treatment. The adoption of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) therefore provides new impetus to explore the right to health, and mental health in particular, for people with mental disabilities. By considering the rights to health in Article 25 and to rehabilitation and habilitation in Article 26, together with the right to exercise legal capacity under Article 12 CRPD and the support paradigm inherent in this, it may be possible to achieve realisation of the right to mental health in its broadest sense.This article explores the links between Article 12, the support paradigm and the right to mental health. It also reflects on the existing legislative and human rights framework within Scotland and explores to what extent the right to mental health is currently being realised. It suggests that fully embracing the rights identified in Articles 12, 25 and 26 CRPD is required to achieve a shift in focus away from inappropriate compulsion and towards providing resources and services to support good mental health which could enable the realisation of the right to mental health at the national level

This paper addresses a central paradox that affects the nature of the student experience in the UK. On the one hand, the marketisation of higher education, with its associated emphasis on performativity indicators, may be seen to have reduced students to numbers, with the attendant consequence that the affective domain of studying and learning has been lost. On the other hand, there is more attention given to student feelings than was ever the case in the past and questions about student satisfaction have become more prominent. This paper will explore this paradox using empirical data gathered from a longitudinal study of ‘non-traditional’ students at one ancient university in Scotland. We indicate the ways in which the tension between the technicist spaces of the neo-liberal university and its empathetic, caring spaces are mediated by students as they make their way through their degrees. We argue that caring relationships with staff are of central importance to students’ well-being and success at university, and that students actively seek to construct support when and where they need it.

Objectives: Cognitive Analytic Therapy (CAT) is an effective psychological intervention for several different mental health conditions. However, whether it is acceptable, safe and beneficial for people with psychosis remains unclear, as is the feasibility of providing and evaluating it within a research context. The aim of the current study was to begin to address these questions, and to obtain for the first time a rich and detailed understanding of the experience of receiving CAT for psychosis.Design: A mixed-methods case series design.Method: Seven individuals who experienced non-affective psychosis received CAT. They completed assessments at the start of CAT, 16 weeks, and 28 weeks post baseline. Qualitative interviews were completed with four individuals following completion of or withdrawal from therapy.Results: Six participants attended at least four sessions of therapy and four went on to complete therapy. There were no serious adverse events and self-reported adverse experiences were minimal. Qualitative interviews suggested CAT is acceptable and provided a way to understand and work therapeutically with psychosis. There was limited evidence of change in psychotic symptoms but improvement in perceived recovery and personality integration was observed. Conclusions: The results suggest that CAT is a safe and acceptable intervention for psychosis. Personality integration, perceived recovery and functioning are relevant outcomes for future evaluations of CAT for psychosis.

BackgroundThe 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.ResultsFifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.ConclusionsThe development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

Background Chlamydia trachomatis (C. trachomatis) is the most common bacterial sexually transmitted infection in the UK. Recent studies suggest that in addition to the genital tract, C. trachomatis is found in the throat and rectum, suggesting the number of infections is under-reported. There is an urgent need to study the impact of extending diagnosis to include extra-genital samples; however, there is a lack of evidence on the acceptability of asking young women to provide these samples. Method A mixed methods single group feasibility study explored the acceptability of combined genital and extra-genital testing in young women aged 16–25 years consecutively attending a sexual health centre in Edinburgh, Scotland. Young women were asked to complete a self- administered anonymous questionnaire whether they would be willing to give self-taken throat and ano-rectal samples. Interviews with women (n = 20) willing to self-sample were conducted before and after self-sampling, and these explored the underlying reasons behind their decision, and feelings about the tests. Results Of 500 women recruited to the study, 422 (84.4%) women provided sufficient data for analysis. From completed questionnaires, 86.3% of respondents reported willingness to self-sample from the throat. Willingness of ano-rectal self-sampling was lower (59.1%), particularly in women under 20 (

Objective: To report the results of the first randomised feasibility trial of Eye MovementDesensitisation and Reprocessing (EMDR) plus Standard Care (SC) vs. SC alone for DSM-5Posttraumatic Stress Disorder (PTSD) in adults with intellectual disabilities (IDs). Method: A total of 29 participants were randomised to either to EMDR + SC (n= 15) or SC (n= 14). Participants completed measures on traumatic stress (PCL-C) and . comorbid distress at baseline, 1-week post-treatment and 3-month follow-up. Results: In the EMDR + SC group, 9 (60%) participants at post-treatment and 7 (47%) participants at 3-month follow-up were diagnosis free. In SC, 4 (27%) at post-treatment and follow-up were diagnosis free. At post-treatment 3 participants (20%) dropped out from the EMDR + SC group, and 1 (7%) dropped out from the SC group. Conclusions: It is feasible, acceptable and potentially effective to deliver EMDR in this population group.

Mental health tribunals are responsible for making decisions about compulsory treatment for individuals considered a risk to themselves and others due to mental disorder. They are generally designed to provide safeguards for individuals subject to compulsory treatment by testing whether national legislative criteria and international human rights standards have been met. Despite this, they have been criticised for being dominated by the medical domain, focusing rigidly on legal criteria and for restricting human rights, including the rights to liberty and access to justice. As a result, questions have arisen over the extent to which mental health tribunals are in‐ deed operating in line with their legislative intentions and international human rights requirements. The aim of this systematic review was to synthesise international evidence on this and to assess the extent to which this is reflected in such literature. A systematic search of the literature was conducted on the 17 April 2018 for articles published between 2000 and 2018 in MEDLINE, CINAHL, PsychINFO, ASSIA and Web of Science. All study designs were included within this review, provided they reported empirical findings. Thirty‐two studies met the inclusion criteria. Eight themes were identified across the literature and these were participation, information and understanding, patient representation, the power of the medical domain, feelings of powerlessness, perceptions of fairness, risk and the impact on relation‐ ships. The findings call into question whether mental health tribunals necessarily operate in compliance with international human rights standards. This article suggests that mental health tribunals may need to do more to safeguard legislative principles and human rights standards that promote patient autonomy.