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IssuesConsideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains.ApproachThree electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies.Key FindingsA total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70).Implications and ConclusionMany instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Aims: This programme of work was stimulated by a gap in knowledge identified in research, policy and practice literature and aimed to develop an item bank to screen for and assess the continuum of alcohol risk and harm in adolescents.Methods: The project adopted a sequential mixed methods design integrating thematic and advanced psychometric analyses. Semi-structured interviews with 44 adolescents in a range of UK settings including: schools, supported accommodation, criminal justice settings, community groups; were conducted to develop and refine item content for screening and assessing alcohol use and consequences identified in a meta-analysis conducted by the authors. The resultant 65 items produced were completed by 381 adolescents, and the 33 items brought forward from this exploratory stage were then tested with 827 adolescents.Results: Exploratory analysis indicated that an item based on heavy episodic drinking is most predictive of full AUDIT score > 8 for screening.The new assessment items have an alpha of 0.92 (adjusted for 10 items), outperforming the best existing instruments.Confirmatory categorical structural equation modelling supported the exploratory results with the best performing screening item: (In the last 3 months) on how many days did you have six or more drinks on the same occasion?The assessment items demonstrated excellent model fit: CFI = 0.99, TLI = 0.99, RMSEA = 0.059 (90% CI: 0.056-0.062) with an alpha value of 0.87 (adjusted for 10 items).Conclusions: The significance of this new item bank for screening and assessing alcohol-related consequences in adolescents, recommendations for further validation and applicability to different practice settings will be discussed.

The assessment and treatment of substance-related and addictive disorders can benefit from a holistic consideration of an individual’s quality of life (QoL), however, there remains uncertainty over how the construct is operationalised as an outcome measure. The current systematic review aimed to identify all the QoL and health-related quality of life (HRQoL) instruments adopted as outcome measures in addiction research and map the conceptualised domains. Available psychometric evidence supporting their use was also summarised. A systematic search of three electronic databases and a specialised assessment library was conducted for studies utilising a QoL or HRQoL instrument as an outcome measure. Participants using or taking part at risky levels and above assessed with a valid measure were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance was followed and included outcome instruments were appraised using mixed-methods. Validation studies were assessed for their risk of bias based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. Two hundred and thirty articles containing 258 discrete studies were included. Forty-seven outcome instruments were used: 28 assessing QoL in 141 studies; 19 assessing HRQoL in 117 studies. The WHOQOL-BREF was the most popular instrument utilised in 73 studies. Content analysis identified 39 unique domains of QoL. Eighteen articles comprising 20 validation studies evaluated the psychometric properties of 11 outcome measures. No instrument was assessed for the same parameter in 5 or more studies for meta-analytic pooling purposes. The ALQoLS, ALQoL-9, Q-LES-Q-SF, SF-36, and WHOQoL-BREF all produced multiple, promising internal consistency statistics (Cronbach’s α = 0.75–0.97), but with varying degrees of methodological quality. Other parameters of reliability and validity are also reported. It is clear many QoL and HRQoL instruments have been utilised in the field. However, a significant portion of studies applied a small number of popular instruments for which there is minimal high-quality validation evidence provided to support their use with populations at risk of addiction. There is a need for more rigorous primary studies with validation evidence presented for the appropriateness of the QoL or HRQoL assessment instrument chosen.

Supplemental material, sj-docx-1-dhj-10.1177_20552076231155684 for The effect of question order on outcomes in the orbital core outcome set for alcohol brief interventions among online help-seekers (QOBCOS): Findings from a randomised factorial trial by Marcus Bendtsen, Claire Garnett, Paul Toner and Gillian W Shorter in Digital Health

Supplemental material, sj-docx-3-dhj-10.1177_20552076231155684 for The effect of question order on outcomes in the orbital core outcome set for alcohol brief interventions among online help-seekers (QOBCOS): Findings from a randomised factorial trial by Marcus Bendtsen, Claire Garnett, Paul Toner and Gillian W Shorter in Digital Health

Supplemental Material for Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence by Catherine Hitch, Paul Toner and Cherie Armour in Journal of Health Services Research & Policy.

Introduction Human-Animal Interaction (HAI) is a broad term that describes a wide spectrum of interactions and relationships between animals and humans(1). At its centre, it recognises the ancient concept of the Human-Animal Bond, defined as mutually beneficial relationships between animals and humans that have demonstrated potential to influence the health and wellbeing of both(2). The possible link between HAIs and human health and wellbeing is attracting growing interest from researchers, the general public and the media(3). The ownership of pets (or ‘companion animals’, to align with terminology commonly used in the field) and its effect on human health and wellbeing is one example of HAI research that has been increasingly popular. Growing numbers of single, mostly observational studies conclude that having a companion animal can be beneficial for human health and wellbeing, for example through hypothesized mechanisms involving attachment to or social support received from the animal(4, 5). On the other hand, a variety of studies suggest that, rather than ‘improving’ owners mental health or wellbeing, strong attachment to companion animals can predict worse outcomes for depression and loneliness(6, 7). Study findings are often specific to ownership of one or two particular animal species (dogs and cats) or human sub populations (i.e. those living alone; bereaved individuals), and there is consensus in this developing, interdisciplinary field that many questions are yet to be answered before credible conclusions relating to the effect of companion animal ownership on human health can be drawn(4, 8). The need for a comprehensive research agenda that integrates the further rigorous investigation of potential underlying mechanisms and of confounding, mediating and moderating variables has been described(4). The importance of integrating validated instruments assessing central variables (e.g. attachment to companion animals), and of developing and validating new brief instruments, for example for inclusion in large population studies(9), has also been highlighted(4). The 2020 Covid-19 pandemic raises previously unexplored questions about the role of interactions and relationships between humans and animals in the context of widely applied social distancing and isolation measures. We plan to conduct a cross-sectional survey study during the Covid-19 ‘lockdown’ phase in the United Kingdom (UK) to explore aspects relating to these questions. We will explore potential associations between ownership of and attachment to (different species of) animals and human wellbeing, mental health and social connectedness outcomes in sub groups of the population in the current crisis. We will also investigate how the pandemic may have influenced aspects of animal ownership, welfare and behaviour. These latter aspects align with the interdisciplinary ‘One Health’ concept(10), in that understanding and addressing the health issues created at the intersection between humans, animals and environment are paramount to creating the potential to improve the health of all. Specifically, this study aims to answer the following main questions: 1. Role of attachment to animals in animal owners during the Covid-19 pandemic • Is the level of attachment to animals associated with/predictive of mental health, wellbeing and loneliness outcomes (pre- and post-lockdown, and change in between) in animal owners, and how does this association differ by animal species, and living circumstances (e.g. individuals living alone vs others)? • Does the level of attachment to animals differ by animal species/type of animal (emotional support animal, assistance dog, working dog, etc.), human age, gender, social isolation status and living circumstances (e.g. living alone) in animal owners? • Does the level of attachment to animals predict/determine identification of animal behaviour change? • Is the level of attachment to animals associated with ‘worries about animals’ reported in the Covid-19 context, and is ‘worry about pets’ correlated with mental health and wellbeing outcomes? 2. Mental health/wellbeing and social connectedness in animal owners and non-owners during the Civid-19 pandemic • Are poorer mental health, wellbeing and social connectedness during lockdown associated with greater likelihood to consider obtaining a new animal in non-pet owners? • Is social isolation due to Covid-19 associated with greater likelihood to report challenges of animal ownership (by species)? • Is social isolation die to Covid-19 associated with differential loneliness outcomes in animal owners compared to non-owners? • Do changes in mental health, wellbeing and loneliness scores pre- and post- lockdown differ by companion animal species in animal owners? • Do changes in mental health, wellbeing and loneliness scores pre- and post-lockdown differ by companion animal ownership status (owners vs non-owners)? • Is the amount of time spent directly engaging with companion animals (by species) or engaging with other animals associated with mental health, wellbeing, loneliness and physical activity outcomes in animal owners and non-owners? 3. Animal ownership during the Covid-19 pandemic • Is ‘living with children’ associated with reported worries or challenges of living with animals during lockdown (including reports of decreased animal welfare or negative animal behaviours)? • How do proximity to green/blue space, financial implications of Covid-19, older age and other factors impact on aspects of animal ownership (including considerations of relinquishing an animal; worries about an animal)? 4. Attachment to companion animals: instrument development In this part of the study, we aim to: • compare the psychometric properties of two existing validated instruments to measure emotional attachment to companion animals(9, 11); • investigate how the two existing instruments, which to our knowledge have only been tested in dog and cat owners, perform in owners of a variety of other animal species, and for different types of animals (assistance dogs, emotional support animals, working dog, therapy animal); • test a new 1-item instrument derived from the existing instruments that might be suitable, as a very brief instrument, for use in larger population survey studies; • and investigate whether adding the new 1-item to the Comfort from Companion Animals Scale(11) may enable better performance of the scale/shortening of its 11-item form. The above list captures the main study questions we aim to answer. Further explorations of novel, Covid-19-related emerging themes and relationships may be undertaken in addition.

The posttraumatic growth Inventory (PTGI) (Tedeschi & Calhoun, 1996) is the most widely used measure of psychological growth following trauma and adversity (Frazier et al., 2009). Originally developed to account for growth across three dimensions (self, interpersonal relationships, and philosophy of life), a principal component analysis (PCA) subsequently revealed five interrelated factors: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life (Tedeschi & Calhoun, 1996). Although specifically designed to assess growth following trauma, its developers suggested it might be a suitable measure of growth resulting from a wide range of experiences, including non-traumatic events (Tedeschi & Calhoun, 2004). Supporting this, the PTGI has now been validated for use with a variety of populations including parents of critically ill children (Rodríguez-Rey, Alonso-Tapia, Kassam-Adams, & Garrido-Hernansaiz, 2016), students attending university (Anderson & Lopez-Baez, 2008), survivors of breast cancer (Brunet, McDonough, Hadd, Crocker, & Sabiston, 2010) and childhood sexual abuse (Saltzman, Easton, & Salas-Wright, 2015), and individuals living with chronic diseases (Purc-Stephenson, 2014). However, there is yet to be any work examining the PTGI for use with substance use populations. The study seeks to answer whether the measure is valid and reliable for use with individuals in recovery from addiction.

This review seeks to systematically identify and synthesise the research which explores the experience of adversarial growth by individuals in recovery from addiction. Due to the scarcity of research and heterogeneity of studies in this area, the review is designed to be exploratory. Articles will be reviewed for information about study design, context, and participant demographics, and the findings/results, conclusions, and recommendations will be examined for themes and discordance.

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