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This thesis examines the relationship between coeliac disease (CD) and disordered eating attitudes and behaviours. The literature review describes the development of a theoretical model of disordered eating in CD that will be evaluated throughout this thesis. Chapter Three reports the results of a study that found a high prevalence of disordered eating in CD. Chapter Four reports the results of a qualitative study; participants in this study discussed an increased concern around food that affected their eating patterns. Chapter Five describes the development and validation of the CD Food Attitudes and Behaviours Scale (CD-FAB), which was designed to assess the increased food concerns reported in CD. Chapter Six reports the results of an online survey that explored the correlates of this tool; participants with increased food concerns were more psychologically distressed and had an impaired quality of life. Chapter Seven reports the results of a laboratory study that explored the relationship between food concerns, food intake and cognitive processes related to eating. Overall, this thesis provides novel experimental and theoretical insights into the relationship between CD and disordered eating. The findings have implications for the management and treatment of people with CD.

Background: There is a complex overlap and high prevalence rate between type 1 diabetes (T1D) and eating disorders. However, screening for disordered eating in young people with T1D may be avoided by diabetes professionals and deterred by parents. More ways of effectively screening for disordered eating in this population are needed and parent reports can be beneficial for early detection of symptoms and engagement in treatment. Aims: This study aimed to validate a parent-reported version of a pre-existing and validated disordered eating screening tool for adolescents with T1D (the Diabetes Eating Problems Survey-Revised; DEPS-R). Methods: The existing DEPS-R was adapted for parent use. During baseline assessment of the wider PRIORITY trial project, 73 parents of adolescents with T1D aged 11-14 years completed the parent-reported DEPS-R and other questionnaires related to demographics, child eating behaviours and quality of life. Adolescents of parent participants were also offered the opportunity to participate, and 40 adolescents completed demographic questions and the original DEPS-R measure. Results: The parent-reported DEPS-R demonstrated good internal consistency (Cronbach's  = 0.827). Moderate to good inter-rater reliability was found between parent-reported DEPS-R and adolescent self-reported DEPS-R measurements (ICC was 0.8, 95% CI = 0.623-0.894, p < 0.001), indicating good convergent validity. Construct validity with specific hypothesised variables, including certain eating behaviours, diabetes-related distress, overall parent quality of life, adolescent BMI, parent gender and parental worry about adolescent disordered eating, suggested that the measure might be valid. However, some hypothesised variables did not significantly correlate with the parent-reported DEPS-R, as expected. Conclusions: The parent-reported DEPS-R has demonstrated good reliability and validity and it may provide clinical benefits of increasing screening and early detection of disordered eating in T1D adolescents. These findings are tentative, due to missing data and small adolescent sample size, and therefore further validation is needed.

Postpartum Post-Traumatic Stress Disorder (PTSD) as a result of traumatic childbirth or the immediate postpartum experience is becoming more widely recognised by society and mental health services. A traumatic stress service in the South of England developed a Psychoeducation and Compassion Resilience Group (PCRG) as a new intervention for postpartum PTSD symptoms. This study aimed to explore group members' perceptions of this group and any effects on symptoms of PTSD, self-criticism and the mother-infant relationship. A mixed methods approach was employed to best address this, analysing quantitative outcome measures using descriptive statistics and reliable change indices, and qualitative data using reflexive thematic analysis. Seven mothers were recruited from the 12-week group, completing outcome measures at three time-points and interviews within a month of the final group session. Four qualitative themes were identified via the reflexive thematic analysis: (1) 'Providers of care: giving with one hand and taking away with the other'; (2) 'The role of others: a blessing or a curse?'; (3) 'Defining improvement: acceptance vs change' and (4) 'Supporting people to support themselves'. Outcome measures showed an improvement across group averages of most symptoms, but very little reliable change. Participants, meanwhile, reported that the PCRG improved the way they felt about their PTSD symptoms, viewing them more compassionately, thus decreasing the distress they caused. Little to no effect of the group was found on the mother-infant relationship.

Part A: This study aimed to understand the impact of COVID-19-related stress, parental technology related interference in child-parent interaction - termed 'technoference' - and social media use on parenting behaviours and child developmental outcomes. A secondary aim was to explore the familial experience of the pandemic. Parents (n = 127) were recruited via an online cross-sectional survey. Data was collected through questionnaires and open-ended comments. Regression analysis indicated that greater parental COVID-19 related stress was associated with more technoference and parent-proxy cognitive deficit scores in children aged 6-11 years old, as well as lower levels of self-reported authoritative parenting, which includes characteristics such as autonomy-granting and warmth. Greater social media use was associated with permissive parenting behaviours, characterised by warmth but less discipline or structure. Parental qualitative responses highlighted many challenges faced by families during the pandemic, with negative mental health changes being the most frequently reported difficulty. Findings and clinical implications are discussed in the context of managing the effect of the pandemic on child development. Part B: This study aimed to understand the impact of the COVID-19 pandemic and paternal depressive symptoms on parenting behaviours and child developmental outcomes. It also aimed to explore the paternal experience of the pandemic. Fathers (n = 87) were recruited for an online cross-sectional survey. Data was collected through questionnaires and open-ended comments. Regression analysis indicated; greater pandemic impact was associated with more self-reported depressive symptoms in fathers. Higher COVID-19 impact scores, but not paternal depression, was linked to less positive parenting behaviours in fathers. Paternal pandemic impact and depression symptoms were negatively associated with child cognitive, emotional, and behavioural outcomes. Qualitative responses from fathers noted that concerns for their children, work and mental health were most prevalent during the pandemic. However, several responders noted no change or positive change during the pandemic. Clinical implications include targeted interventions and psychoeducation for fathers that acknowledge difference in paternal coping and support seeking.

Introduction. Students often have a variety of stressors, such as leaving home, losing support networks, changing finances, and starting their degree. They are less likely to engage in helpseeking behaviours which has contributed to more university students in the UK reporting problems with their mental health and wellbeing than ever before. Currently, universities offer a mixture of face-to-face and digital support, with digital mental health (DMH) packages increasingly available despite a lack of research into how student's experience using them. These packages often have elements of computerised CBT (cCBT) or digital peer support where students are supported anonymously by other students. This study intended to qualitatively explore some university student's experiences of using these DMH packages. Method. Eleven participants from universities across the UK took part in a semi-structured interview exploring their experiences of using DMH packages. A reflexive thematic analysis (Braun & Clarke, 2019) was used to analyse their findings. Analysis & Discussion. Six themes were generated: "Signposted to self-reliance", "It'd be nice to talk to someone", "It's a community, but not a true community", "Easy in, easy out", "I felt like I was doing another uni course", and "It's a safe space". There was a wealth of information available to participants via DMH packages, but some felt forced to use it or did not get sufficient staff support. Reading similar experiences from other students normalised some student's distress but made others feel worse. Some students queried whether they should be supporting other students, considering they are seeking support themselves. Recommendations. Further research should explore how to best create online peer support communities for university students, and to explore which university students would most benefit from cCBT and/or digital peer support communities, as they do not appear suitable for all students.