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1. Mental health and socio-cognitive predictors of adherence to COVID-19 social distancing rules in adolescents in England

Author

Giacomo Bignardi, Saz P. Ahmed, Marc Bennett, Darren Dunning, Kirsty Griffiths, Jovita T. Leung, Ashok Sakhardande, Blanca Piera Pi-Sunyer, Willem Kuyken, Tim Dalgleish, and Sarah-Jayne Blakemore

Subjects
Science (General), Q1-390, Social sciences (General), H1-99
Abstract

The COVID-19 pandemic prompted governments worldwide to introduce social distancing measures, including school closures and restrictions on in-person socialising. However, adherence to social distancing was challenging for many – particularly adolescents, for whom social interaction is crucial for development. The current study aimed to identify individual-level influences on adherence to social distancing in a longitudinal sample of adolescents aged 11–20 years in England, who took part in a randomised controlled trial. At baseline, 460 participants completed detailed pre-pandemic assessments, including mental health and well-being, altruism, delayed reward discounting, rejection sensitivity, prosociality and susceptibility to prosocial and anti-social influence. Of these, 205 participants reported their compliance with COVID-19 social distancing rules and attendance at social gatherings between June and August 2020. Bayesian ordinal regression models were used to predict adherence to social distancing from predictors, controlling for age at pandemic, gender, day of assessment, and intervention group. The results indicated that higher levels of prosociality, altruism and lower susceptibility to anti-social influence were associated with higher adherence to social distancing. Pre-pandemic levels of depression, anxiety, delayed reward discounting, rejection sensitivity, conduct problems and emotional awareness were not robustly related to the outcomes. These findings have implications for understanding how adolescents comply with public health guidelines, highlighting the role of social influence and peer norms.

Published
2025
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2. Variation in decomposition stages and carrion insect succession in a dry tropical climate and its effect on estimating postmortem interval

Author

Kirsty Griffiths, Matt N. Krosch, and Kirsty Wright

Subjects
forensic sciences, forensic entomology, postmortem interval, diptera, coleoptera, decomposition, Criminal law and procedure, K5000-5582, Public aspects of medicine, RA1-1270
Abstract

Insects have an important role in minimum postmortem interval (PMImin) estimation. An accurate PMImin estimation relies on a comprehensive study of the development and succession of local carrion insects. No published research on carrion insect succession exists for tropical north Queensland. To address this, we aimed to obtain preliminary observational data concerning the rate of decomposition and insect succession on pig carcasses in Townsville and compare these with other regions of Australia and overseas. Adult insects were collected daily from three pig carcasses for 30 d during summer and identified to family level. Observations of decomposition rate were made each day and progression through the stages of decomposition were recorded. Adult insects were identified to family and their presence/absence used as a proxy for arrival at/departure from the remains, respectively. These preliminary data highlight several interesting trends that may be informative for forensic PMImin estimation. Decomposition was rapid: all carcasses were at the dry/remains stage by Day 5, which was substantially quicker than all other regions in the comparison. Differences were also observed in the presence/absence of insect families and their arrival and departure times. Given the rapid progression through early decomposition, we argue that later-arriving coleopteran taxa may be more forensically informative in tropical Australia, in contrast with temperate regions where Diptera appear most useful. This research contributes preliminary observational data to understanding insect succession patterns in tropical Australia and demonstrates the critical need for comprehensive local succession data for each climatic region of Australia to enable accurate PMImin estimation. These data will inform future research targeted at gaining a more comprehensive understanding of insect succession in the Australian tropics.Key points: We obtained preliminary observational data concerning the rate of decomposition and insect succession on pig carcasses in tropical Australia. Decomposition was rapid: all carcasses were at the dry/remains stage by Day 5. Coleopteran taxa may be more forensically informative in tropical Australia than dipterans.

Published
2020
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3. Protocol for a randomised controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: the decentering in adolescence study (DECADES)

Author

Susan Ball, Tamsin Ford, Tim Dalgleish, Willem Kuyken, Kate Tudor, Peter Watson, Maris Vainre, Gemma Wright, Kirsty Griffiths, J Mark G Williams, Sarah-Jayne Blakemore, Katie Fletcher, Hannah Clegg, Poushali Ganguli, Darren Dunning, Nicola Dalrymple, Jem Shackleford, Saz Ahmed, Lucy Foulkes, Cait Griffin, Konstantina Komninidou, Suzannah Laws, Jovita Leung, Jenna Parker, Blanca Piera Pi-Sunyer, Brian Wainman, Marc P Bennett, Rachel Clare Knight, Alan Archer-Boyd, Edwin Dalmaijer, Tierney So, Bert Lenaert, and J Ashok Sakhardande

Subjects
Medicine
Abstract

Introduction Decentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap.Methods and analysis Adolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16–19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models.Ethics and dissemination This study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals.Trial registration number ISRCTN14329613.

Published
2022
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4. Do Adolescents Like School-based Mindfulness Training? Predictors of Mindfulness Practice and Responsiveness in the MYRIAD Trial

Author

Jesus Montero-Marin, Verena Hinze, Catherine Crane, Nicola Dalrymple, Maria E.J. Kempnich, Liz Lord, Yasmijn Slaghekke, Kate Tudor, Sarah Byford, Tim Dalgleish, Tamsin J. Ford, Mark T. Greenberg, Obioha C. Ukoumunne, J. Mark.G. Williams, Willem Kuyken, Saz Ahmed, Matt Allwood, Louise Aukland, Susan Ball, Marc Bennett, Sarah-Jayne Blakemore, Triona Casey, Katherine De Wilde, Darren Dunning, Eleanor-Rose Farley, Katie Fletcher, Lucy Foulkes, Poushali Ganguli, Cait Griffin, Kirsty Griffiths, Ben Jones, and Nils Kappelmann

Subjects
Psychiatry and Mental health, Developmental and Educational Psychology
Published
2023
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5. A randomised controlled feasibility trial (the HARMONIC Trial) of a novel modular transdiagnostic intervention—Shaping Healthy Minds—versus psychological treatment-as-usual, for clinic-attending adults with comorbid mood, stressor-related and anxiety disorders

Author

Melissa Black, David Johnston, Rachel Elliott, Cliodnha O'Leary, Shivam Patel, Alicia Smith, Jenna Parker, Kirsty Griffiths, Kristel Klaus, James Clarke, Peter Watson, Louise Lafortune, Sarah Rae, Edward R Watkins, Simon Gilbody, Willem Kuyken, Caitlin Hitchcock, Jill Newby, Anna Bevan, and Tim Dalgleish

Abstract

This trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds) designed to address the gap in effective interventions for people with complex and comorbid presentations including anxiety, disturbed mood, and trauma sequelae. Shaping Healthy Minds is a modular intervention which synthesises several evidence-based treatment techniques, allowing for standardised, yet flexible, treatment delivery. We conducted a patient-level two-arm randomised controlled trial (HARMONIC) that compared Shaping Healthy Minds to psychological treatment-as-usual (PTAU) for individuals aged >18 years (n = 42). Participants met criteria for at least two comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorder diagnoses and were recruited from outpatient psychological services within the UK National Health Service (NHS). This early phase trial aimed to estimate the efficacy, feasibility, and acceptability of the transdiagnostic intervention. We obtained estimates of likely effect size and acquired basic demographic, cognitive and behavioural data to assess potential mediators and moderators of outcome in preparation for a later phase fully-powered efficacy trial. Co-primary outcomes were self-reported depression and anxiety symptoms, disability and functional impairment; and the trial provided point estimates of efficacy for Shaping Healthy Minds versus Psychological TAU with moderate effect sizes in favour of Shaping Healthy Minds at post-treatment (Cohen’s d estimates ranging from 0.60-0.92) and at 3-month follow-up (Cohen’s d 0.41-0.48). Secondary outcomes included number of diagnoses and changes in transdiagnostic processes. The project has demonstrated that a full trial is feasible, and that the Shaping Healthy Minds treatment approach appears likely to be efficacious compared to PTAU. The trial procedures were approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). The results of this feasibility trial will inform future large-scale trials of psychological interventions for co-occurring mood, anxiety, and stressor-related disorders.Trial registration NCT03143634.

Published
2023
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6. The Role of Schools in Early Adolescents’ Mental Health: Findings From the MYRIAD Study

Author

Tamsin Ford, Michelle Degli Esposti, Catherine Crane, Laura Taylor, Jesús Montero-Marín, Sarah-Jayne Blakemore, Lucy Bowes, Sarah Byford, Tim Dalgleish, Mark T. Greenberg, Elizabeth Nuthall, Alice Phillips, Anam Raja, Obioha C. Ukoumunne, Russell M. Viner, J. Mark G. Williams, Matt Allwood, Louise Aukland, Tríona Casey, Katherine De Wilde, Eleanor-Rose Farley, Nils Kappelmann, Liz Lord, Emma Medlicott, Lucy Palmer, Ariane Petit, Isobel Pryor-Nitsch, Lucy Radley, Lucy Warriner, Anna Sonley, Willem Kuyken, Saz Ahmed, Susan Ball, Marc Bennett, Nicola Dalrymple, Darren Dunning, Katie Fletcher, Lucy Foulkes, Poushali Ganguli, Cait Griffin, Kirsty Griffiths, Konstantina Komninidou, Rachel Knight, Suzannah Laws, Jovita Leung, Jenna Parker, Blanca Piera Pi-Sunyer, J. Ashok Sakhardande, Jem Shackleford, Kate Tudor, Maris Vainre, and Brian Wainman

Subjects
Male, Gerontology, Adolescent, Cost-Benefit Analysis, media_common.quotation_subject, education, Population, Disease cluster, Pupil, law.invention, Promotion (rank), Randomized controlled trial, law, Developmental and Educational Psychology, Humans, Mainstream, 0501 psychology and cognitive sciences, Child, School Health Services, media_common, education.field_of_study, Schools, 05 social sciences, Mental health, United Kingdom, Psychiatry and Mental health, Mental Health, Well-being, Female, Psychology, Mindfulness, 050104 developmental & child psychology
Abstract

Recent studies suggest mental health in youths is deteriorating. The current policy in the United Kingdom emphasizes the role of schools for mental health promotion and prevention, but little data exist on what aspects of schools influence mental health in pupils. This study explored school-level influences on the mental health of young people in a large school-based sample from the United Kingdom.Baseline data from a large cluster randomized controlled trial collected between 2016 and 2018 from mainstream secondary schools selected to be representative in relation to their quality rating, size, deprivation, mixed or single-sex pupil population, and country were analyzed. Participants were pupils in their first or second year of secondary school. The study assessed whether school-level factors were associated with pupil mental health.The study included 26,885 pupils (response rate = 90%; age range, 11‒14 years; 55% female) attending 85 schools in the United Kingdom. Schools accounted for 2.4% (95% CI: 2.0%‒2.8%; p .0001) of the variation in psychopathology, 1.6% (95% CI: 1.2%‒2.1%; p .0001) of depression, and 1.4% (95% CI: 1.0%‒1.7%; p .0001) of well-being. Schools in urban locations, with a higher percentage of free school meals and of White British, were associated with poorer pupil mental health. A more positive school climate was associated with better mental health.School-level variables, primarily related to contextual factors, characteristics of pupil population, and school climate, explain a small but significant amount of variability in mental health of young people. This information might be used to identify schools that are in need of more resources to support mental health of young people.MYRIAD: My Resilience in Adolescence, a Study Examining the Effectiveness and Cost-Effectiveness of a Mindfulness Training Programme in Schools Compared With Normal School Provision; https://www.isrctn.com/; 86619085.

Published
2021
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7. Does depression moderate the relationship between pain and suicidality in adolescence? A moderated network analysis

Author

Isobel Pryor-Nitsch, Catherine Crane, Eleanor-Rose Farley, Anna Sonley, Jeremy Shackleford, Alice Philips, Jovita T. Leung, Poushali Ganguli, Suzannah Laws, Ashok Sakhardande, Sarah Byford, Keith Hawton, Katherine De Wilde, Kirsty Griffiths, Lucy Foulkes, Obioha C Ukoumunne, Maris Vainre, Marc Bennett, Jonas M. B. Haslbeck, J. Mark G. Williams, Jesus Montero-Marin, Susan Ball, Mark T. Greenberg, Triona Casey, Bergljot Gjelsvik, Tim Dalgleish, Rachel Knight, Katie Fletcher, Sarah-Jayne Blakemore, Darren Dunning, Ariane Petit, Liz Lord, Saz P. Ahmed, Blanca Piera Pi-Sunyer, Anam Raja, Lucy Warriner, Nils Kappelmann, Lucy Radley, Tamsin Ford, Elizabeth Nuthall, Willem Kuyken, Russell M Viner, Emma Medlicott, Matt Allwood, Lucy Palmer, Brian Wainman, Verena Hinze, Laura K. Taylor, Louise Aukland, and Psychologische Methodenleer (Psychologie, FMG)

Subjects
Adolescent, media_common.quotation_subject, Pain, Anxiety, Suicidality, Inhibitory control, Self-harm, Humans, Medicine, Association (psychology), Depressive symptoms, Depression (differential diagnoses), media_common, Depression, business.industry, Odds ratio, Adolescence, Suicide, Psychiatry and Mental health, Clinical Psychology, Cross-Sectional Studies, Increased risk, Network analysis, Psychological resilience, medicine.symptom, business, Research Paper, Clinical psychology
Abstract

Highlights • One-in-five adolescents reported suicidality or pain. • Pain was associated with an increased risk of suicidality and vice versa (OR=4.00). • Network analysis supported the pain-suicidality association (aOR=1.39). • This cross-sectional association was not moderated by depression. • Pain should be considered as a key risk correlate of suicidality in adolescents., Background Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms. Methods We performed secondary analyses on cross-sectional, pre-intervention data from the ‘My Resilience in Adolescence’ [MYRIAD] trial (ISRCTN ref: 86619085; N=8072, 11-15 years). Using odds ratio tests and (moderated) network analyses, we investigated the relationship between pain and suicidality, after controlling for depression, anxiety, inhibitory control deficits and peer problems. We investigated whether depression moderates this relationship and explored gender differences. Results Overall, 20% of adolescents reported suicidality and 22% reported pain, whilst nine percent of adolescents reported both. The experience of pain was associated with a four-fold increased risk of suicidality and vice versa (OR=4.00, 95%-CI=[3.54;4.51]), with no gender differences. This cross-sectional association remained significant after accounting for depression, anxiety, inhibitory control deficits and peer problems (aOR=1.39). Depression did not moderate the pain-suicidality association. Limitations The item-based, cross-sectional assessment of pain and suicidality precludes any conclusions about the direction of the effects and which aspects of suicidality and pain may drive this association. Conclusions Our findings underscore the need to consider pain as an independent risk correlate of suicidality in adolescents. Longitudinal research should examine how this relationship develops during adolescence. Clinically, our findings emphasise the need to assess and address suicidality in adolescents with pain, even in the absence of depressive symptoms.

Published
2021
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8. Affective control in adolescence: The influence of age and mental health status on working memory

Author

Kirsty Griffiths, Darren Lee Dunning, Jenna Parker, Marc Patrick Bennett, Susanne Schweizer, Lucy Foulkes, Saz Ahmed, Jovita Tung Leung, Cait Griffin, Ashok Sakhardande, Willem Kuyken, J Mark G Williams, Sarah-Jayne Blakemore, Tim Dalgleish, and Jason Stretton

Abstract

People exhibit marked individual variation in their ability to exercise cognitive control in affectively-charged situations. Affective control is typically assessed in laboratory settings by comparing performance in carefully constructed executive tasks performed in both affectively neutral (‘cool’) and affectively-charged (‘hot’) contexts. Whilst there is some evidence that affective control undergoes significant improvement throughout adolescence, it is not clear if this follows a linear trajectory. Moreover, it is unclear how adolescents deemed at risk of developing depression exercise affective control despite poor affective control being identified as a contributing factor to ongoing mental ill-health in adulthood. The current study therefore investigated affective control in a large (n=425) sample of adolescents (aged 11-18 years). A visuospatial search and written storage Working Memory (WM) capacity task was carried out to examine affective control, using affectively-neutral and affectively-negative social images as the task-irrelevant distractors. Overall, WM capacity increased as a function of age across both affective conditions. Moreover, we report a significant difference between affective conditions, with WM capacity slightly lower during trials with affectively-negative social scenes, relative to neutral. The performance ‘cost’ for completing the task in negative relative to neutral conditions was not modulated by depressive risk. Furthermore, age did not predict performance cost, irrespective of risk group. These findings suggest WM capacity is relatively robust against socio-affective contexts and mood in adolescents.

Published
2022
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9. Converging evidence for enduring perceptions of low social status in individuals in remission from depression

Author

Julia Gillard, Jason Stretton, Tim Dalgleish, Caitlin Hitchcock, Kirsty Griffiths, Siobhan Gormley, Griffiths, Kirsty [0000-0001-7158-2683], Hitchcock, Caitlin [0000-0002-2435-0713], Dalgleish, Tim [0000-0002-7304-2231], and Apollo - University of Cambridge Repository

Subjects
genetic structures, media_common.quotation_subject, Vulnerability, Major depressive disorder, Anxiety, behavioral disciplines and activities, Remitted depression, Perception, medicine, History of depression, Humans, Community sample, Depression (differential diagnoses), media_common, business.industry, Depression, medicine.disease, Mental health, Social status, Psychiatry and Mental health, Clinical Psychology, Case-Control, Cross-Sectional Studies, Psychological Distance, sense organs, medicine.symptom, business, psychological phenomena and processes, Clinical psychology, Research Paper
Abstract

Highlights • Perception of low social status is a risk factor for depression. • Investigated social status in a community sample and a case control design. • BDI score associated with perceptions of low social status in a community sample. • Perceptions of low social status endured in clinical remission from depression., Background : The risk of depressive relapse and recurrence is associated with social risk factors that may be amplified by a submissive socio-cognitive profile. Methods : In Study 1 we aimed to identify perceptions of low social status in a community sample (N = 613) with a self-reported history of mental health difficulties (n = 232) and, more specifically in Study 2 (N = 122), in individuals in clinical remission from depression (n = 18), relative to a never-depressed control group (n = 64), and relative to a group experiencing a current depressive episode (n = 40). Results : In Study 1, a total of 225 of the 232 participants in the self-reported mental health difficulties group opted to provide further information regarding their mental health history, of whom 153 (68%) reported a history of anxiety, 168 (74.7%) reported a history of depression, and 13 (5.8%) reported an unspecified mental health history. Elevated depressive symptoms were associated with perceptions of low social status which significantly differed between individuals with and without a self-reported history of mental health difficulties. In Study 2 we found enduring perceptions of low social status in remitted depressed individuals. Limitations : We were unable to discern between historical or current clinical diagnosis in the community sample of Study 1, as we were reliant on self-report. We were unable to explore the effects of medication or causal relationships between depressive symptoms and social status as the studies were cross-sectional in nature. Conclusions : These findings suggest that evolutionarily rooted socio-cognitive profiles could impact affiliative processes and may confer increased vulnerability to future depressive episodes.

Published
2021

10. Susceptibility to prosocial and antisocial influence in adolescence following mindfulness training

Author

Jovita Tung Leung, Blanca Piera Pi-Sunyer, Saz Ahmed, Lucy Foulkes, Cait Griffin, Ashok Sakhardande, Marc Patrick Bennett, Darren Lee Dunning, Kirsty Griffiths, Jenna Parker, Willem Kuyken, J Mark G Williams, Tim Dalgleish, Sarah-Jayne Blakemore, Leung, Jovita T [0000-0002-1577-9243], Piera Pi-Sunyer, Blanca [0000-0002-6707-9943], Ahmed, Saz P [0000-0002-3533-409X], Blakemore, Sarah-Jayne [0000-0002-1690-2805], and Apollo - University of Cambridge Repository

Subjects
mindfulness, education, Developmental and Educational Psychology, adolescence, social influence
Abstract

Funder: Jacobs Foundation; Id: http://dx.doi.org/10.13039/501100003986, Funder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265, Funder: University of Cambridge; Id: http://dx.doi.org/10.13039/501100000735, Funder: Wellspring Foundation, Mindfulness training programmes have shown to encourage prosocial behaviours and reduce antisocial tendencies in adolescents. However, less is known about whether training affects susceptibility to prosocial and antisocial influence. The current study investigated the effect of mindfulness training (compared with an active control) on self-reported prosocial and antisocial tendencies and susceptibility to prosocial and antisocial influence. 465 adolescents aged 11-16 years were randomly allocated to one of two training programmes. Pre- and post-training, participants completed a social influence task. Self-reported likelihood of engaging in prosocial and antisocial behaviours did not change post-training, and regardless of training group, participants showed a higher propensity for prosocial influence than for antisocial influence. Finally, participants were less influenced by antisocial ratings following both training programmes.

Published
2022
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11. Memory bias for social hierarchical information is modulated by perceived social rank

Author

Tim Dalgleish, Kirsty Griffiths, Jason Stretton, Griffiths, Kirsty [0000-0001-7158-2683], and Apollo - University of Cambridge Repository

Subjects
Computer science, business.industry, social hierarchy, Rank (computer programming), Hierarchy, Social, social rank, Text mining, Arts and Humanities (miscellaneous), Bias, Memory, self-enhancement bias, Statistics, Humans, business, General Psychology, Memory bias
Abstract

Hierarchies pervade human society, characterizing its members along diverse dimensions ranging from their abilities or skills in a particular domain to their economic status or physical stature. One intriguing aspect of the centrality of hierarchies, relative to egalitarian constructs, is that hierarchically-organized social information appears to be remembered more easily than non-hierarchically-organized information. However, it is not yet clear how one’s social rank within a hierarchy influences processing. In a pre-registered study with 66 healthy participants, we examined memory recall for hierarchical information when participants themselves were positioned higher in the hierarchy versus lower in the hierarchy, both relative to an egalitarian control condition. The results replicate previous work showing that hierarchical information is memorized faster relative to the egalitarian control. Importantly, this effect was modulated by the participant’s position within the hierarchy, with higher-positioned participants memorizing information faster than lower-positioned participants. This study provides new evidence about the interaction of perceptions of one’s own social status with memory for social hierarchical information.

Published
2022
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12. The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds

Author

Kirsty Griffiths, Benjamin Goodall, Julia Gillard, Caitlin Hitchcock, Patrick Smith, Richard Meiser-Stedman, Adrian Boyle, Ayla Humphrey, Inderpal Panesar, Isobel Wright, Darren L. Dunning, David Johnston, Anna McKinnon, Peter Watson, Tim Dalgleish, Aliza Werner-Seidler, Hitchcock, Caitlin [0000-0002-2435-0713], Meiser-Stedman, Richard [0000-0002-0262-623X], and Apollo - University of Cambridge Repository

Subjects
Adult, Pediatrics, medicine.medical_specialty, medicine.medical_treatment, behavioral disciplines and activities, law.invention, Stress Disorders, Post-Traumatic, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), mental disorders, Developmental and Educational Psychology, medicine, Prevalence, Humans, 0501 psychology and cognitive sciences, Child, young children, Cognitive Behavioral Therapy, 05 social sciences, Attendance, Treatment options, Posttraumatic stress disorder, Acute Stress Disorder, randomized control trial, Hospitals, Cognitive behavioral therapy, Psychotherapy, Psychiatry and Mental health, Posttraumatic stress, Child, Preschool, Pediatrics, Perinatology and Child Health, Cognitive therapy, Psychology, 030217 neurology & neurosurgery, 050104 developmental & child psychology
Abstract

Background The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. Method Study 1 (N = 105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. Results In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. Conclusions The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted.

Published
2022

13. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Author

B Carter, J Law, J Hewitt, K L Parmar, J M Boyle, P Casey, I Maitra, L Pearce, S J Moug, Bryony Ross, Julia Oleksiewicz, Nicola Fearnhead, Christopher Jump, Jemma Boyle, Alex Shaw, Jonathan Barker, Jane Hughes, Jonathan Randall, Isileli Tonga, James Kynaston, Matthew Boal, Nicola Eardley, Elizabeth Kane, Harriet Reader, Sunanda Roy Mahapatra, Michael Garner-Jones, Jessica Juliana Tan, Said Mohamed, Rina George, Ed Whiteman, Kamran Malik, Christopher J Smart, Monica Bogdan, Madhu Parna Chaudhury, Videha Sharma, Daren Subar, Panna Patel, Sok-Moi Chok, Evelyn Lim, Vedamurthy Adhiyaman, Glesni Davies, Ellen Ross, Rudra Maitra, Colin W Steele, Campbell Roxburgh, Shelly Griffiths, Natalie S Blencowe, Emily N Kirkham, John S Abraham, Kirsty Griffiths, Yasser Abdulaal, Muhammad Rafaih Iqbal, Munir Tarazi, James Hill, Azam Khan, Ian Farrell, Gemma Conn, Jugal Patel, Hyder Reddy, Janahan Sarveswaran, Lakshmanan Arunachalam, Afaq Malik, Luca Ponchietti, Krystian Pawelec, Yan Mei Goh, Parveen Vitish-Sharma, Ahmed Saad, Edward Smyth, Amy Crees, Louise Merker, Nahida Bashir, Gethin Williams, Jennifer Hayes, Kelly Walters, Rhiannon Harries, Rahulpreet Singh, Nikola A Henderson, Francesco M Polignano, Ben Knight, Louise Alder, Alexandra Kenchington, Yan Li Goh, Ilaria Dicurzio, Ewen Griffiths, Ahmed Alani, Katrina Knight, Patrick MacGoey, Guat Shi Ng, Naomi Mackenzie, Ishaan Maitra, Susan Moug, Kelly Ong, Daniel McGrath, Emanuele Gammeri, Guillame Lafaurie, Gemma Faulkner, Gabriele Di Benedetto, Julia McGovern, Bharathi Subramanian, Sunil Kumar Narang, Jennifer Nowers, Neil J Smart, Ian R Daniels, Massimo Varcada, Tanzeela Gala, Julie Cornish, Zoe Barber, Stephen O'Neill, Richard McGregor, Andrew G Robertson, Simon Paterson-Brown, Thomas Raymond, Mohamed A Thaha, William J English, Cillian T Forde, Heidi Paine, Alpa Morawala, Ravindra Date, Patrick Casey, Thomas Bolton, Xuan Gleaves, Joshua Fasuyi, Sanja Durakovic, Matt Dunstan, Sophie Allen, Angela Riga, Jonathan Epstein, Lyndsay Pearce, Emily Gaines, Anthony Howe, Halima Choonara, Ffion Dewi, Joanne Bennett, Emile King, Kathryn McCarthy, Greg Taylor, Dean Harris, Hari Nageswaran, Amy Stimpson, Kamran Siddiqui, Lay In Lim, Christopher Ray, Laura Smith, Gillian McColl, Mohammed Rahman, Aaron Kler, Abhi Sharma, Kat Parmar, Neil Patel, Perry Crofts, Claudio Baldari, Rhys Thomas, Michael Stechman, Roland Aldridge, James O'Kelly, Graeme Wilson, Nicholas Gallegos, Ramya Kalaiselvan, Rajasundaram Rajaganeshan, Aliya Mackenzie, Prashant Naik, Kaushiki Singh, Harinath Gandraspulli, Jeremy Wilson, Kate Hancorn, Amir Khawaja, Felix Nicholas, Thomas Marks, Cameron Abbott, and Susan Chandler

Subjects
Male, medicine.medical_specialty, Frail Elderly, medicine.medical_treatment, Decision Making, MEDLINE, Comorbidity, 030230 surgery, Risk Assessment, Preoperative care, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, Risk Factors, Laparotomy, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Geriatric Assessment, Aged, Aged, 80 and over, Frailty, business.industry, Odds ratio, Length of Stay, medicine.disease, Patient Discharge, Emergency medicine, Care level, Female, Surgery, Emergencies, business, Follow-Up Studies, Abdominal surgery
Abstract

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores ( 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.

Published
2020
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14. Susceptibility to prosocial and antisocial influence in adolescence

Author

Marc Bennett, Jovita T. Leung, Jeffrey Williams, C. Griffin, Lucy Foulkes, Jenna Parker, Tim Dalgleish, Kirsty Griffiths, Sarah-Jayne Blakemore, Saz P. Ahmed, Ashok Sakhardande, Willem Kuyken, Darren L. Dunning, Griffiths, Kirsty [0000-0001-7158-2683], Dalgleish, Tim [0000-0002-7304-2231], Blakemore, Sarah-Jayne [0000-0002-1690-2805], and Apollo - University of Cambridge Repository

Subjects
Male, Social Psychology, Adolescent, media_common.quotation_subject, 050109 social psychology, Social behaviour, Article, Developmental psychology, Social influence, Surveys and Questionnaires, Social cognitive development, London, Developmental and Educational Psychology, Humans, 0501 psychology and cognitive sciences, Child, media_common, 05 social sciences, Social change, Prosocial, Puberty, Antisocial Personality Disorder, Altruism, Maturity (psychological), Adolescence, Psychiatry and Mental health, Cross-Sectional Studies, Prosocial behavior, Adolescent Behavior, Pediatrics, Perinatology and Child Health, Female, Psychology, 050104 developmental & child psychology, Antisocial
Abstract

Introduction Adolescents are particularly susceptible to social influence and previous studies have shown that this susceptibility decreases with age. The current study used a cross-sectional experimental paradigm to investigate the effect of age and puberty on susceptibility to both prosocial and antisocial influence. Methods Participants (N = 520) aged 11–18 from London and Cambridge (United Kingdom) rated how likely they would be to engage in a prosocial (e.g. “help a classmate with their work”) or antisocial (e.g. “make fun of a classmate”) act. They were then shown the average rating (in fact fictitious) that other adolescents had given to the same question, and were then asked to rate the same behaviour again. Results Both prosocial and antisocial influence decreased linearly with age, with younger adolescents being more socially influenced when other adolescents’ ratings were more prosocial and less antisocial than their own initial rating. Both antisocial and prosocial influence significantly decreased across puberty for boys but not girls (independent of age). Conclusions These findings suggest that social influence declines with increasing maturity across adolescence. However, the exact relationship between social influence and maturity is dependent on the nature of the social influence and gender. Understanding when adolescents are most susceptible to different types of social influence, and how this might influence their social behaviour, has important implications for understanding adolescent social development.

Published
2020

15. Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials

Author

Darren L. Dunning, Tim Dalgleish, Willem Kuyken, Kirsty Griffiths, Lucy Foulkes, Jenna Parker, Catherine Crane, Griffiths, Kirsty [0000-0001-7158-2683], Dalgleish, Tim [0000-0002-7304-2231], Apollo - University of Cambridge Repository, Dalgleish, Timothy [0000-0002-7304-2231], and Kuyken, Willem [0000-0002-8596-5252]

Subjects
050103 clinical psychology, Mindfulness, Adolescent, Behavioral Symptoms, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intervention (counseling), Developmental and Educational Psychology, medicine, Humans, 0501 psychology and cognitive sciences, Cognitive Dysfunction, 030212 general & internal medicine, Child, intervention, Randomized Controlled Trials as Topic, 05 social sciences, Gold standard, Cognition, Mental health, 3. Good health, attention, meta-analysis, Psychiatry and Mental health, Meta-analysis, Pediatrics, Perinatology and Child Health, Anxiety, adolescence, medicine.symptom, Psychology, Clinical psychology
Abstract

Background Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta‐analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design. Methods A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty‐three independent studies including 3,666 children and adolescents were included in random effects meta‐analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta‐analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition. Results Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only. Conclusions This meta‐analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled‐up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

Published
2019

16. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS) : a pragmatic, double-blind, randomised, controlled trial

Author

Martin Dennis, Gillian Mead, John Forbes, Catriona Graham, Maree Hackett, Graeme J Hankey, Allan House, Stephanie Lewis, Erik Lundström, Peter Sandercock, Karen Innes, Carol Williams, Jonathan Drever, Aileen Mcgrath, Ann Deary, Ruth Fraser, Rosemary Anderson, Pauli Walker, David Perry, Connor Mcgill, David Buchanan, Yvonne Chun, Lynn Dinsmore, Emma Maschauer, Amanda Barugh, Shadia Mikhail, Gordon Blair, Ingrid Hoeritzauer, Maggie Scott, Greig Fraser, Katherine Lawrence, Alison Shaw, Judith Williamson, David Burgess, Malcolm Macleod, Dan Morales, Frank Sullivan, Marian Brady, Ray French, Frederike Van Wijck, Caroline Watkins, Fiona Proudfoot, Joanna Skwarski, Diane Mcgowan, Rachael Murphy, Seona Burgess, William Rutherford, Katrina Mccormick, Ruaridh Buchan, Allan Macraild, Ruth Paulton, Adnan Fazal, Pat Taylor, Ruwan Parakramawansha, Neil Hunter, Jack Perry, John Bamford, Dean Waugh, Emelda Veraque, Caroline Bedford, Mary Kambafwile, Luis Idrovo, Linetty Makawa, Paula Smalley, Marc Randall, Tharani Thirugnana-Chandran, Ahamad Hassan, Richard Vowden, Joanne Jackson, Ajay Bhalla, Anthony Rudd, Chi Kai Tam, Jonathan Birns, Charlotte Gibbs, Leonie Lee Carbon, Elizabeth Cattermole, Katherine Marks, Angela Cape, Lisa Hurley, Sagal Kullane, Nigel Smyth, Charlotte Eglinton, Jennifer Wilson, Elio Giallombardo, Angela Frith, Paul Reidy, Matthew Pitt, Lucy Sykes, Deborah Dellafera, Victoria Croome, Lauriane Kerwood, Mirea Hancevic, Christina Narh, Carley Merritt, John Duffy, Duncan Cooke, Juliet Willson, Ali Ali, Aaizza Naqvi, Christine Kamara, Helen Bowler, Simon Bell, Tracy Jackson, Kirsty Harkness, Kathy Stocks, Suzanna Duty, Clare Doyle, Geoffrey Dunn, Keith Endean, Fiona Claydon, Emma Richards, Jo Howe, Ralf Lindert, Arshad Majid, Katy Dakin, Ahmad Maatouk, Luke Barron, Madana Meegada, Pratap Rana, Anand Nair, Christine Brighouse-Johnson, Jill Greig, Myint Kyu, Sanjeev Prasad, Matthew Robinson, Irfan Alam, Belinda Mclean, Lindsay Greenhalgh, Zenab Ahmed, Christine Roffe, Susan Brammer, Carole Beardmore, Kay Finney, Adrian Barry, Paul Hollinshead, Jeanette Grocott, Holly Maguire, Indira Natarajan, Jayan Chembala, Ranjan Sanyal, Sue Lijko, Nenette Abano, Alda Remegoso, Phillip Ferdinand, Stephanie Stevens, Resti Varquez, Chelsea Causley, Adrian Butler, Philip Whitmore, Caroline Stephen, Racquel Carpio, Joanne Hiden, Girish Muddegowda, Hayley Denic, Jane Sword, Ross Curwen, Martin James, Paul Mudd, Fiona Hall, Julie Cageao, Samantha Keenan, Caroline Roughan, Hayley Kingwell, Anthony Hemsley, Christoph Lohan, Sue Davenport, Angela Bowring, Tamika Chapter, Max Hough, David Strain, Karin Gupwell, Keniesha Miller, Anita Goff, Ellie Cusack, Shirley Todd, Rebecca Partridge, Georgiana Jennings, Kevin Thorpe, Jacquelyn Stephenson, Kelly Littlewood, Mark Barber, Fiona Brodie, Steven Marshall, Derek Esson, Irene Coburn, Caroline Mcinnes, Fiona Ross, Emma Bowie, Heather Barcroft, Victoria Withers, Laura Miller, Paul Willcoxson, Michelle Donninson, Richard Evans, Di Daniel, John Coyle, Michael Keeling, Peter Wanklyn, Mark Elliott, John Wightman, Elizabeth Iveson, Natasha Dyer, Anne-Marie Porteous, Monica Haritakis, Mandy Ward, Lucy Doughty, Lisa Carr, Mark O Neill, Cosmas Anazodo, Paul Wood, Poppy Cottrell, Cheryl Donne, Romina Rodriguez, Ruhail Mir, Jax Westmoreland, Judith Bell, Christopher Emms, Lorraine Wright, Pearl Clark Brown, Elizabeth Bamford, Andrew Stanners, Mike Carpenter, Prabal Datta, Richard Davey, Ann Needle, Marjorie Jane Eastwood, Fathima Zeena Razik, Imran Ghouri, Gavin Bateman, Judy Archer, Venkatesh Balasubramanian, Richard Bowers, Julie Ball, Louise Benton, Linda Jackson, Julie Ellam, Kate Norton, Paul Guyler, Terry Dowling, Sharon Tysoe, Paula Harman, Ashish Kundu, Ololade Omodunbi, Thayalini Loganathan, Stuart Chandler, Shanas Noor, Anwer Siddiqui, Amber Siddiqui, Swapna Kunhunny, Devesh Sinha, Martin Sheppard, Sindhu Rashmi, Elena France, Rajalakshmi Orath Prabakaran, Laura Wilson, Amiirah Ropun, Shyam Kelavkar, Kheng Xiong Ng, Lucy Kamuriwo, Sweni Shah, David Mangion, Camen Constantin, Luigi De Michele Hock, Anne Hardwick, Jayne Borley, Skarlet Markova, Kimberley Netherton, Tara Lawrence, Jo Fletcher, Rebecca Spencer, Helen Palmer, Claire Cullen, Dolores Hamill, Ramesh Durairaj, Zoe Mellor, Tanya Fluskey, Diane Wood, Alison Keeling, Victoria Hankin, Jennifer Peters, Daniela Shackcloth, Thant Hlaing, Rebecca Tangney, Jordan Ewing, Melanie Harrison, Sarah Stevenson, Victoria Sutton, Mohamed Soliman, Julia Hindle, Elizabeth Watson, Claire Hewitt, Susie Butler, Ibrahim Wahishi, Sarwat Arif, Amy Fields, Jagdish Sharma, Rose Brown, Caroline Taylor, Sarah Bell, Simon Leach, Chris Patterson, Sophia Khan, Helen Wilson, Joanne Price, Hawraman Ramadan, Stuart Maguire, Ruth Bellfield, Michaela Hooley, Umair Hamid, Waqar Gaba, Robina Ghulam, Leslie Masters, Outi Quinn, Lakshmanan Sekaran, Margaret Tate, Niaz Mohammed, Kiranjit Bharaj, Frances Justin, Rajan Pattni, Lanka Alwis, Sakthivel Sethuraman, Rianne Robinson, Lianne Eldridge, Susan Mintias, Meena Chauhan, Chi-Kai Tam, Jeremias Palmones, Clare Holmes, Lucy Belle Guthrie, Mairead Osborn, Lindsay Ball, Sarah Caine, Amy Steele, Peter Murphy, Nikki Devitt, Jayne Leonard, Ronak Patel, Ian Penwarden, Emily Dodd, Amy Holloway, Pauline Baker, Samantha Clarke, Sandra Williams, Lindsey Dow, Roland Wynn-Williams, James Kennedy, Rachel Teal, Ursula Schulz, Gary Ford, Philip Mathieson, Ian Reckless, Ana Deveciana, Paige Mccann, Gillian Cluckie, Geoffrey Howell, Jonathan Ayer, Barry Moynihan, Rita Ghatala, Brian Clarke, Geoffrey Cloud, Bhavini Patel, Usman Khan, Nia Al-Samarrai, Sarah Trippier, Neha Chopra, Temi Adedoyin, Fran Watson, Val Jones, Liqun Zhang, Lillian Choy, Rebecca Williams, Natasha Clarke, Adrian Blight, Kate Kennedy, Alice Dainty, Johann Selvarajah, Dheeraj Kalladka, Bharath Cheripelli, Wilma Smith, Fiona Moreton, Angela Welch, Xuya Huang, Elizabeth Douglas, Audrey Lush, Nicola Day, Salwa El Tawil, Karen Montgomery, Helen Hamilton, Doreen Ritchie, Sankaranarayanan Ramachandra, Kirsty Mcleish, Kamy Thavanesan, Sathyabama Loganathan, Josh Roberts, Chantel Cox, Sarah Orr, Alison Hogan, Divya Tiwari, Gail Hann, Barbara Longland, Owen David, Jo Bell, Catherine Ovington, Emily Rogers, Rachel Bower, Marketa Keltos, David Cohen, Joseph Devine, Lankantha Alwis, Lucy Southworth, Laura Burgess, Matilda Lang, Bhavna Badiani, Fenglin Guo, Anne Oshodi, Emmanuelle Owoyele, Norah Epie, Anette David, Mushiya Mpelembue, Rajaram Bathula, Mudhar Abdul-Saheb, Angela Chamberlain, Varthi Sudkeo, Khalid Rashed, Barbara Williams-Yesson, Joanne Board, Sarah De Bruijn, Clare Buckley, Sarah Board, Joanna Allison, Elizabeth Keeling, Tracey Duckett, Dave Donaldson, Carinna Vickers, Claire Barron, Linda Balian, Jodhi Wilson, Adam Edwards, Timothy England, Amanda Hedstrom, Elizabeth Bedford, Margaret Harper, Elina Melikyan, Wendy Abbott, Kashmira Subramanian, Marie Goldsworthy, Meena Srinivasan, Angela Yeomans, Denise Donaldson, Frances Hurford, Riquella Chapman, Sana Shahzad, Nicki Motherwell, Louise Tonks, Rachel Young, Usman Ghani, Indranil Mukherjee, Dipankar Dutta, Mudhar Obaid, Pauline Brown, Fiona Davis, Deborah Ward, Jennifer Turfrey, Bethan Cartwright, Bilal Topia, Judith Spurway, Kayleigh Collins, Rehana Bakawala, Chloe Hughes, Susan Oconnell, Linda Hill, Kausik Chatterjee, Tim Webster, Syed Haider, Pamela Rushworth, Fiona Macleod, Arumugam Nallasivan, Charlotte Perkins, Edel Burns, Sandra Leason, Tom Carter, Samantha Seagrave, Eman Sami, Lisa Armstrong, Syed Naseem Naqvi, Muhammad Hassan, Sharron Parkinson, Samantha Mawer, Gillian Darnbrook, Carl Booth, Brigid Hairsine, Matthew Smith, Sue Williamson, Fiona Farquhar, Bernard Esisi, Tim Cassidy, Gavin Mankin, Beverley Mcclelland, Maria Bokhari, David Sproates, Elliot Epstein, Steve Hurdowar, Ruth Blackburn, Nazran Sukhdeep, Saika Razak, Khalid Osman, Amina Hashmi, Natasha Upton, Frances Harrington, Gillian Courtauld, Christine Schofield, Linda Lucas, Katja Adie, Kirsty Bond, Abhijit Mate, Jo Skewes, Ali James, Carolyn Brodie, Matthew Johnson, Linda Allsop, Emma Driver, Karina Harris, Mark Drake, Sam Ellis, Bev Maund, Emma Thomas, Kimberley Moore, Matthew Burn, Adam Hamilton, Shageetha Mahalingam, Amulya Misra, Farrah Reid, Adrienne Benford, Derek Hilton, Lorraine Hazell, Keziah Ofori, Anne Louise Thomas, Moncy Mathew, Sonia Dayal, Iona Burn, Kenneth Fotherby, Karla Jennings-Preece, Angela Willberry, Debbie Morgan, Donna Butler, Gurminder Sahota, Kelly Kauldhar, Nasar Ahmad, Angela Stevens, Saugata Das, David Bruce, Yogish Pai, Khin Nyo, Lynsey Stephenson, Richard Nendick, Gill Rogers, Mahesh Dhakal, Sofia Dima, Ellen Brown, Susan Clayton, Penny Gamble, Muhammad Naeem, Rachel Hayman, Rachel Burnip, Philip Earnshaw, David Hargroves, Barbara Ransom, Hannah Rudenko, Ibrahim Balogun, Kirsty Griffiths, Kim Mears, Tom Webb, Linda Cowie, Tessa Hammond, Audrey Thomson, Daniela Ceccarelli, Navraj Chattha, Eva Beranova, Anna Verrion, Andrew Gillian, Natasha Schumacher, Anna Bahk, Susannah Walker, Vera Cvoro, Nicola Chapman, Susan Pound, Rebecca Cain, Sean Mcauley, Mandy Couser, Maria Simpson, Athan Tachtatzis, Khalil Ullah, Don Sims, Rachael Jones, Jonathan Smith, Rebecca Tongue, Mark Willmot, Claire Sutton, Edward Littleton, Jattinder Khaira, Susan Maiden, James Cunningham, Carole Green, Yin-May Chin, Michelle Bates, Katherine Ahlquist, Ingrid Kane, Joanna Breeds, Tenesa Sargent, Laura Latter, Alexandra Pitt Ford, Nicola Gainsborough, Tom Levett, Philip Thompson, Emma Barbon, Angela Dunne, Simon Hervey, Suzanne Ragab, Tracy Sandell, Christine Dickson, Judith Dube, Sharon Power, Nick Evans, Beverley Wadams, Savina Elitova, Beth Aubrey, Tatiana Garcia, James Mcilmoyle, Carol Jeffs, Christina Dickinson, Anis Ahmed, Sanjeev Kumar, Julie Frudd, Charlotte Armer, Andrew Potter, Stacey Donaldson, Joanne Howard, Kirsty Jones, Saikat Dhar, David Collas, Saul Sundayi, Lynn Denham, Deepali Oza, Elaine Walker, Mohit Bhandari, Sissy Ispoglou, Rachel Evans, Kamel Sharobeem, Elaine Walton, Steven Shanu, Anne Hayes, Jennifer Howard-Brown, Steven Billingham, Nic Weir, Vanessa Pressly, Emma Wood, Gabriella Howard, Holly Burton, Pam Crawford, Shuna Egerton, Sue Evans, Jasmine Hakkak, Janet Andrews, Rebecca Lampard, Christopher Allen, Ashleigh Walters, Rasha Said, James Richard Marigold, Sau-Mon Tsang, Robyn Creeden, Chloe Cox, Simon Smith, Imogen Gartrell, Fiona Smith, Colin Jenkins, Joanna Pryor, Andrew Hedges, Fiona Price, Linda Moseley, Lily Mercer, Claire Hughes, Abul Azim, Julie White, Milena Krasinska-Chavez, Shaun Chaplin, James Curtis, Deepwant Singh, Javed Imam, Anne Nicolson, Sajid Alam, Simon Whitworth, Lisa Wood, Elizabeth Warburton, Siobhan Kelly, Joanne Mcgee, Hugh Markus, Denish Chandrasena, Derek Hayden, Juliana Sesay, Helen Hayhoe, Mark Bolton, Jane Macdonald, Jenny Mitchell, Charlotte Farron, Elaine Amis, Diana Day, Ainsley Culbert, Ailene Espanol, Niamh Hannon, Dominic Handley, Sarah Finlay, Sarah Crisp, Lynne Whitehead, Jobbin Francis, Janice Oconnell, Emily Osborne, Rod Beard, Ramesh Krishnamurthy, Langanani Mokoena, Naweed Sattar, Min Myint, Michelle Edwards, Andrew Smith, Paul Corrigan, Anthony Byrne, Joanne Blackburn, Caroline Mcghee, Amanda Smart, Fiona Donaldson, Claire Copeland, Jill Wilson, Rhona Scott, Paul Fitzsimmons, Paula Lopez, Mark Wilkinson, Aravindakshan Manoj, Penelope Cox, Leona Trainor, Glyn Fletcher, Lisa Denny, Karen Kavanagh, Hannah Allsop, Hedley Emsley, Sulaiman Sultan, Alison Mcloughlin, Benjamin Walmsley, Louise Hough, Shakeel Ahmed, Donna Doyle, Bindu Gregary, Sonia Raj, Kirubananthan Nagaratnam, Neelima Mannava, Nyla Haque, Norma Shields, Kate Preston, Geraldine Mason, Kirsty Short, Gemma Lumsdale, Giulia Uitenbosch, Ugnius Sukys, Stacey Valentine, David Jarrett, Kerry Dodsworth, Mary Wands, Nisa Khan, Jane Tandy, Catrin Watkinson, Wendy Golding, Rebecca Butler, Max Williams, Yasmin Davies, Keith Yip, Claire James, Anne Suttling, Aditya Maney, Giles Edward Gamble, Adam Hague, Bethan Charles, Sujata Blane, Beatriz Duran, Caroline Lambert, Katherine Stagg, Robert Whiting, Jane E Homan, Sarah Brown, Malik Hussain, Miriam Harvey, Libby Graham, Leanne Foote, Catherine Lane, Liz (Joan) Kemp, Joy Rowe, Helen Durman, Jayne Foot, Lucy Brotherton, Nicholas Hunt, Corinne Pawley, Alison Whitcher, Patrick Sutton, Susan Mcdonald, Denys Pak, Alison Wiltshire, Jennifer Jagger, Anthony K Metcalf, Gail Louise Healey, Joyce Balami, Clare Marie Self, Melissa Crofts, Annie Chakrabarti, Chit Hmu, Garth Ravenhill, Charmaine Grimmer, Thandar Soe, Jocelyn Keshet-Price, Margaret Langley, Ian Potter, Pui-Lin Tam, Mary Joan Macleod, Patricia Cooper, Michael Christie, Janice Irvine, Faye Annison, David Christie, Celia Meneses, Amber Johnson, Anu Joyson, Sandra Nelson, Vicky Taylor, John Reid, Rebecca Clarke, Jacqueline Furnace, Heather Gow, Youssif Abousleiman, Tania Beadling, Sally Collins, Stuart Jones, Jessica Purcell, Samantha Bloom, Shelly Goshawk, Marcial Landicho, Sivatharshini Sangaralingham, Yasmin Begum, Sherree Mutton, Elangovan Munuswamy Vaiyapuri, Jane Allen, Jemma Lowe, Martin Hughes, Ivan Wiggam, Sarah Cuddy, Suzanne Tauro, Brian Wells, Azlisham Mohd Nor, Nicola Persad, Maggie Kalita, Stuart Weatherby, Claire Brown, Adrian Pace, Daniel Lashley, Mike Marner, Marie Weinling, Natasha Wilmshurst, Darren Waugh, Anna Mucha, Alex Shah, John Baker, Jacqueline Westcott, Richard Cowan, Evangelos Vasileiadis, Samira Mumani, Anthea Parry, Cathy Mason, Melinda Holden, Katerina Petrides, Tomoko Nishiyama, Hina Mehta, Manju Krishnan, Dacey Lynne, Lisa Thomas, Connor Lynda, Catherine Hughes, Clare Clements, Rhys Williams, Tal Anjum, Storton Sharon, Susan Tucker, Paul Jones, Deanne Colwill, Helen Thompson Jones, Dinesh Chadha, Mark Fairweather, Deborah Walstow, Rosanna Fong, Stuart Johnston, Christine Almadenboyle, Sarah Ross, Shona Carson, Priya Nair, Emily Tenbruck, Mairi Stirling, Aparna Pusalkar, Hannah Beadle, Kelly Chan, Puneet Dangri, Asaipillai Asokanathan, Anita Rana, Sunita Gohil, Mark Massyn, Prabhu Aruldoss, Angela Cook, Karen Crabtree, Sura Dabbagh, Toby Black, Caroline Clarke, Denise Mead, Ruth Fennelly, Alpha Anthony, Linda Nardone, Victoria Dimartino, Michele Tribbeck, David Broughton, Dinesh Tryambake, Lynn Dixon, Agnieszka Skotnicka, Jane Thompson, Sarah Whitehouse, Andrew Sigsworth, Jason Wong, Arunkumar Annamalai, Julie Pagan, Brendan Affley, Caroline Sunderland, Lynda Goldenberg, Atif Khan, Peter Wilkinson, Raad Nari, Lucy Abbott, Emma Young, Amritpal Shakhon, Sally Lock, Jack Stewart, Rita Pereira, Margaret Dsouza, Sally Dunn, Anne-Marie Mckenna, Nina Cron, Michelle Kidd, Grace Hull, Kerry Bunworth, Graham Drummond, Karim Mahawish, Nicola Hayes, Lynne Connell, Jennifer Simpson, Helen Penney, Shuja Punekar, Joanne Nevinson, William Wareing, Jacqueline Ward, Richard Greenwood, Duncan Austin, Azra Banaras, Carolin Hogan, Thomas Corbett, Nnebuife Oji, Emma Elliott, Maria Brezitski, Nathalie Passeron, Laura Howaniec, Caroline Watchurst, Krishna Patel, Renuka Erande, Rahi Shah, Nabarun Sengupta, Maria Metiu, Celia Gonzalez, Sarah Funnell, Jordi Margalef, Gillian Peters, Indra Chadbourn, Ramachandran Sivakumar, Rajesh Saksena, Jane Ketley-O'donel, Richard Needle, Elaine Chinery, Alison Wright, Sue Cook, Joseph Ngeh, Harald Proeschel, Paige Cook, Pauline Ashcroft, Simon Sharpe, Stephanie Jones, Damian Jenkinson, Deborah Kelly, Holly Bray, Gunaratnam Gunathilagan, Sally Jones, Sorrell Tilbey, Saidu Abubakar, Joseph Vassallo, Dee Leonard, Lucy Orrell, Aziz Hasan, Asif Khan, Sulmaaz Qamar, Susan Graham, Emma Hewitt, Jennifer Awolesi, Muhammad Haque, Alissa Kent, Elizabeth Bradshaw, Martin Cooper, Inez Wynter, Anoja Rajapakse, Joumana Janbieh, Abu M Nasar, Lynne Wade, Linda Otter, Steve Haigh, Jamie-Rae Burgoyne, Rebecca Boulton, Andrew Boulton, Rayessa Rayessa, Emma Clarkson, Horne Rhian, Amy Fleming, Kim Mitchelson, Vicki Lowthorpe, Ahmed Abdul-Hamid, Phil Jones, Claire Duggan, Abigail Hynes, Emma Nurse, Syed Abid Raza, Sarah Jones, Udaya Pallikona, Bleddyn Edwards, Geraint Morgan, Kirsty Dennett, Helen Tench, Ronda Loosley, Toby Trugeon-Smith, Rhian Jones, Richard Williams, Donna Robson, Sunanda Mavinamane, Sanjeevi Meenakshisundaram, Lalitha Ranga, Sharon Dealing, Andrew Hill, Margaret Hargreaves, Tom Smith, Julie Bate, Linda Harrison, Ramanathan Kirthivasan, Emma Cannon, Joanne Topliffe, Rebecca Keskeys, Sarah Williams, Fiona Mcneela, Frances Cairns, Thomas James, Amanda Lyle, Sheela Shah, George Zachariah, Lauren Fergey, Susan Smolen, Lucy Cooper, Elizabeth Bohannan, Siddiq Omer, Sageet Amlani, Nadia Hunter, Melissa Hawkes-Blackburn, Giosue Gulli, Alice Peacocke, Justine Amero, Maria Burova, Ottilia Speirs, Steph Levy, Lynda Francis, Susan Holland, Sean Brotheridge, Helen Lyon, Christine Hare, Samantha Jackson, Lorraine Stephenson, Samer Al Hussayni, James Featherstone, Agness Bwalya, Arun Singh, M N Goorah, Jamie Walford, Angela Bell, Christine Kelly, Darren Rusk, Deborah Sutton, Farzana Patel, Stephen Duberley, Kathryn Hayes, Lorraine Hunt, Ahmed El Nour, Sacha Honour, Chloe Box, Simon Dyer, Lynne Brown, Kerry Elliott, Emma Temlett, John Paterson, Rosie Furness, Shelli Young, Enoch Orugun, Chris Brewer, Sarah Thornthwaite, Hannah Crowther, Rachel Glover, Moe Sein, Kashif Haque, Elspeth Gibson, Sam Wong, Karen Rotchell, Karen Burton, Lisa Brookes, Linda Bailey, Chris Lindley, Abbi Murray, Karen Waltho, Maureen Holland, Pradeep Kumar, Purnima Harlekar, Laura Booth, Charlotte Culmsee, Jade Drew, Mohammad Khan, Nicola Mackenzie, Carmel Thomas, Jane Ritchie, James Barker, Michael Haley, Donna Cotterill, Lynne Lane, Christine Little, Dawn Simmons, Glenn Saunders, Harvey Dymond, Sarah Kidd, Rachel Warinton, Yara Neves-Silva, Branimir Nevajda, Michael Villaruel, Udayaraj Umasankar, Seema Patel, Anna Man, Natasha Christmas, Ravi Rangasamy, Richard Ladner, Georgina Butt, Wilson Alvares, Narasimha Gadi, Michael Power, Belinda Wroath, Kevin Dynan, David Wilson, Sarah Crothers, Catherine Leonard, Samantha Hagan, Geraldine Douris, Djamil Vahidassr, Alastair Thompson, Brian Gallen, Shirley Mckenna, Collette Edwards, Clare Mcgoldrick, Murdi Bhattad, Khalil Kawafi, Deborah Morse, Patricia Jacob, Lisa Turner, Narayanamoorti Saravanan, Linda Johnson, Sadie Humphrey, Robert Namushi, Ramesh Patel, Jemma Mclaughlin, Paul Omahony, Esther Osikominu, Chukwuka Orefo, Chisha Mcdonald, Esther Makanju, Tabindah Khan, Grace Appiatse, Helena Stone, Martia Augustin, Alicia Wardale, Maqsud Salehin, Duncan Bailey, Luciano Garcia-Alen, Latheef Kalathil, Sarah Tinsley, Taya Jones, Kelly Amor, Andrew Ritchings, Emma Margerum, Jane Horton, Richard Miller, Nireekshana Gautam, Julie Meir, Amaryl Jones, Janet Putteril, Mirella Lepore, Rachel Gallifent, Laura-Louise Arundell, Catherine Mcredmond, Alicia Goulding, Vivek Nadarajan, Julia Laurence, Su Fung Lo, Sabina Melander, Paul Nicholas, Elizabeth Woodford, Gillian Mckenzie, Vietland Le, Jacolene Crause, Robert Luder, Maneesh Bhargava, Girish Bhome, Venetia V Johnson, Dara Chesser, Hayley Bridger, Elodie Murali, Jon Scott, Susan Morrison, Amy Burns, Julie Graham, Madeline Duffy, Khalid Ali, Emma Pitcher, Jane Gaylard, Julie Newman, Sunil Punnoose, Sarah Besley, Kirtan Purohit, Amy Rees, Mark Davy, Osman Chohan, Muhammad Fozan Khan, Rachel Walker, Vicky Murray, Charlotte Bent, Susan Oakley, Cassilda Peixoto, Suzanne Jones, Gaybrielle Livingstone, Fiona Butler, Sally Bradfield, Laura Gordon, Jenneke Schmit, Anika Wijewardane, Tineke Edmunds, Rebecca Wills, Catherine Medcalf, Lucia Argandona, Larissa Cuenoud, Hanna Hassan, Esther Erumere, Aidan Ocallaghan, Patrick Gompertz, Ozlem Redjep, Grace Auld, Anna Song, Tillana Tarkas, Hashim Kabash, Rumbi Hungwe, University of St Andrews. Sir James Mackenzie Institute for Early Diagnosis, University of St Andrews. Population and Behavioural Science Division, and University of St Andrews. School of Medicine

Subjects
RM, medicine.medical_specialty, Neurology, Neurologi, NDAS, 030204 cardiovascular system & hematology, Placebo, Minimisation (clinical trials), Article, B700, law.invention, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, Modified Rankin Scale, law, Fluoxetine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, R2C, Acute stroke, business.industry, ~DC~, General Medicine, Odds ratio, RM Therapeutics. Pharmacology, Stroke, RC Internal medicine, BDC, business, Selective Serotonin Reuptake Inhibitors, RC, medicine.drug
Abstract

Background: Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.Methods: FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.Findings: Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.Interpretation: Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.Funding: UK Stroke Association and NIHR Health Technology Assessment Programme.

Published
2019
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17. Study protocol for a randomised, controlled platform trial estimating the effect of autobiographical Memory Flexibility training (MemFlex) on relapse of recurrent major depressive disorder

Author

Siobhan Gormley, Caitlin Hitchcock, Cliodhna O'Leary, Emily Hammond, Evangeline Rodrigues, Tim Dalgleish, Aliza Werner-Seidler, Isobel Wright, Kirsty Griffiths, Julia Gillard, and Peter Watson

Subjects
Research design, 050103 clinical psychology, medicine.medical_specialty, medicine.medical_treatment, Cost-Benefit Analysis, Memory, Episodic, 050105 experimental psychology, Patient Education as Topic, Recurrence, medicine, Protocol, Humans, 0501 psychology and cognitive sciences, Single-Blind Method, Psychiatry, Self report, Protocol (science), Depressive Disorder, Major, clinical trials, Cognitive Behavioral Therapy, business.industry, Autobiographical memory, 05 social sciences, Recurrent major depressive disorder, Flexibility (personality), General Medicine, Cognitive behavioral therapy, Clinical trial, Logistic Models, Mental Health, England, Research Design, Self Report, adult psychiatry, business
Abstract

Introduction Major depressive disorder (MDD) is a chronic condition. Although current treatment approaches are effective in reducing acute depressive symptoms, rates of relapse are high. Chronic and inflexible retrieval of autobiographical memories, and in particular a bias towards negative and overgeneral memories, is a reliable predictor of relapse. This randomised controlled single-blind trial will determine whether a therapist-guided self-help intervention to ameliorate autobiographical memory biases using Memory Flexibility training (MemFlex) will increase the experience of depression-free days, relative to a psychoeducation control condition, in the 12 months following intervention. Methods and analysis Individuals (aged 18 and above) with a diagnosis of recurrent MDD will be recruited when remitted from a major depressive episode. Participants will be randomly allocated to complete 4 weeks of a workbook providing either MemFlex training, or psychoeducation on factors that increase risk of relapse. Assessment of diagnostic status, self-report depressive symptoms, depression-free days and cognitive risk factors for depression will be completed post-intervention, and at 6 and 12 months follow-up. The cognitive target of MemFlex will be change in memory flexibility on the Autobiographical Memory Test- Alternating Instructions. The primary clinical endpoints will be the number of depression-free days in the 12 months following workbook completion, and time to depressive relapse. Ethics and dissemination Ethics approval has been granted by the NHS National Research Ethics Committee (East of England, 11/H0305/1). Results from this study will provide a point-estimate of the effect of MemFlex on depressive relapse, which will be used to inform a fully powered trial evaluating the potential of MemFlex as an effective, low-cost and low-intensity option for reducing relapse of MDD. Trial registration number NCT02614326.

Published
2018

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