The impact of postpartum psychosis on partners

Background Postpartum Psychosis is a severe mental health condition following childbirth, with a psychosis and associated mood disturbance. Research to date has primarily focused on mothers’ experiences, and on identifying risk factors, aetiology, and intervention efficacy. Within both research and clinical communities, there has been little acknowledgement of partners’ experiences of Postpartum Psychosis, nor the important support role that partners can provide. The aim of this study was to consider the lived experiences of partners of women who have had Postpartum Psychosis, and the impact that it has had on their lives and relationships. Methods Participants (N = 8) were partners recruited through the charity Action on Postpartum Psychosis. Partners completed an in-depth, semi-structured interview regarding their experiences of Postpartum Psychosis. Interpretative Phenomenological Analysis was used to analyse the interview transcripts. Results Seven superordinate themes emerged from the interview data: loss; powerlessness; united vs. individual coping; hypothesising and hindsight; barriers to accessing care and unmet needs; managing multiple roles; and positive changes from Postpartum Psychosis

An exploration of the role of occupational therapists in addressing sexuality with service users post stroke

Introduction: Research suggests stroke negatively affects sexuality yet is rarely addressed by healthcare professionals. This study aims to explore occupational therapists’ perceptions of addressing sexuality post stroke with service users and whether they perceive it to fit into their scope of practice. Method: A qualitative study was undertaken following an inductive reasoning approach. Three occupational therapists working within stroke rehabilitation were purposively recruited. Data were gathered through semi-structured interviews and analysed using in- ductive thematic analysis to generate four significant themes. Findings: Findings generated the following themes: (1) Acknowledging the impact stroke has on sexuality. (2) Consideration of the appropriate stage of the stroke journey to address sexuality; identifying home/community environments to be more appropriate, utilising a multi-disciplinary approach to facilitate this. (3) Barriers to addressing sexuality, including staff’s personal feelings, inexperience, limited resources and ageism. (4) Facilitators to addressing sexuality, including approaching the topic appropriately and utilising the role of occupational therapy and resources. Conclusion: This study highlights the gap in the stroke journey where sexuality lies and the role occupational therapists can play in closing this gap. Utilising facilitators such as resources and a multi-disciplinary approach can overcome barriers to practice including embarrassment, prejudice and inexperience

Child Acute Malnutrition and Mortality in Populations Affected by Displacement in the Horn of Africa, 1997–2009

Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997–2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < −2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997–2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20–25% GAM in pastoral populations and 10–15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives

The antecedents and outcomes of persistent and remitting adolescent depressive symptom trajectories:a longitudinal, population-based English study

Background Depression often first emerges in adolescence and, for many, is a lifelong disorder. The long-term clinical course of depression is highly variable. We aimed to examine the adult outcomes of adolescent-onset trajectories of clinically significant depressive symptoms and to identify factors differentiating trajectories that persist and desist in adulthood. Methods We included participants from the English population-based Avon Longitudinal Study of Parents and Children with data on depressive symptoms. Self-reported depression symptoms were assessed on ten occasions when participants were age 10·5–25 years using the short Mood and Feelings Questionnaire, and major depressive disorder episodes were assessed at age 13·0 years, 15·0 years, 17·5 years, and 25·0 years. We characterised trajectories of depression symptoms using latent class growth analysis, for which we required depression data at least once from each of three key phases: ages 10·5–13·5 years; 16·5–18·5 years; and 21–25 years. We examined adult outcomes by assessing lifetime suicidal self-harm and functional impairment at age 24·0 years, and employment, education, and the self-reported Strengths and Difficulties Questionnaire at age 25·0 years. Findings We studied 4234 participants: 2651 (63%) female, 1582 (37%) male, and one individual with missing sex data. The mean age was 10·6 years (SD 0·2) at baseline and 25·8 years (SD 0·5) at the final timepoint. Data on ethnicity were not available in our data set. We identified four depression trajectory classes: adolescent-persistent depression with onset early in adolescence (7%, n≈279), adolescent-limited depression with onset later in adolescence and remittance by adult life (14%, n≈592), adult-increasing depression (25%, n≈1056), and stable-low levels of depression (54%, n≈2307). The adolescent-persistent class was associated with poor adult outcomes for functional impairment (62%), suicidal self-harm (27%), mental health difficulties (25%), and not being in education, employment, or training (16%). Adolescent-limited depression was associated with transient adolescent stress, but by early adulthood functional impairment and mental health difficulties were similar to the stable-low group. Major depressive disorder polygenic score (odds ratio [OR] 1·36, 95% CI 1·04–1·79), adolescent educational attainment (OR 0·47, 0·30–0·74), and any early childhood adversity (OR 2·60, 1·42–4·78), that persisted into adulthood (OR 1·60, 1·38–1·87) distinguished the adolescent-persistent and adolescent-limited groups. Interpretation The future course of adolescent depression can be differentiated by age at onset during adolescence, adolescent academic attainment, early and persistent adversity, and genetic loading. A detailed social and educational history could be helpful in making clinical decisions about the intensity of interventions for young people with clinically elevated depressive symptoms who seek help

Following the children of depressed parents from childhood to adult life: A focus on mood and anxiety disorders

BACKGROUND: Parental depression increases risk for anxiety and depression in offspring. The transition from adolescence to adulthood is a common risk period for onset of such disorders. However, relatively few studies have considered development of these disorders from childhood to adulthood including multiple assessments during this transition period. METHOD: Offspring of depressed parents aged 9–17 years at baseline were followed prospectively for 13 years (n = 337). Average length of follow-up was 16 months between the first and second waves, 13 months between the second and third, and 8 years between the third and fourth. Current (3-month) psychopathology was assessed at each wave using diagnostic interviews. We derived estimates of 3-month prevalence, age at first diagnosis, course and comorbidity of disorders. Social functioning in adult life was assessed at the final wave and we assessed how prior and current disorder impacted adult functioning. RESULTS: A quarter of young people met criteria for a mood disorder and a third for anxiety disorder at least once. Mood and anxiety disorder prevalence increased from 4.5% and 15.8% respectively in childhood (9–11 years) to 22.3% and 20.9% respectively by age 23–28. Increased prevalence across the transition from adolescence to adulthood was particularly marked in males, while prevalence increased earlier in adolescence in females. Age at first diagnosis varied widely (mood disorder mean = 16.5 years (range 9–26); anxiety disorder mean = 14.5 years (range 9–28)). Over half (52%) reported functional impairment in early adulthood, 31% harmful alcohol use, and 10% self-harm or a suicide attempt. Both previous and current mood or anxiety disorder were associated with functional impairment in early adulthood. CONCLUSIONS: There is a prolonged risk period for mood and anxiety disorders in this group, with prevalence peaking in early adulthood. This highlights the need for prolonged vigilance and effective targeted interventions in the offspring of depressed parents

Commentary: reconstructing four centuries of temperature-induced coral bleaching on the great barrier reef

Coral reefs are spectacular ecosystems found along tropical coastlines where they provide goods and services to hundreds of millions of people. While under threat from local factors, coral reefs are increasingly susceptible to ocean warming from anthropogenic climate change. One of the signature disturbances is the large-scale, and often deadly, breakdown of the symbiosis between corals and dinoflagellates. This is referred to as mass coral bleaching and often causes mass mortality. The first scientific records of mass bleaching date to the early 1980s (Hoegh-Guldberg et al., 2017). Kamenos and Hennige (2018, hereafter KH18), however, claim to show that mass coral bleaching is not a recent phenomenon, and has occurred regularly over the past four centuries (1572–2001) on the Great Barrier Reef (GBR), Australia. They support their claim by developing a putative proxy for coral bleaching that uses the suggested relationship between elevated sea surface temperatures (SSTs) and reduced linear extension rates of 44 Porites spp. coral cores from 28 GBR reefs. If their results are correct, then mass coral bleaching events have been a frequent feature for hundreds of years in sharp contrast to the vast majority of scientific evidence. There are, however, major flaws in the KH18 methodology. Their use of the Extended Reconstructed Sea Surface Temperature (ERSST) dataset (based on ship and buoy observations) for reef temperatures from 1854 to 2001, ignores the increasing unreliability of these data which become sparse, less rigorous, and more interpolated going back in time. To demonstrate how the quality of these data degrades, we plot the average number of SST observations per month that contribute to each 200 x 200 km ERSST pixel (Figure 1A, black line). Note that from 1854 to 1900 the four ERSST pixels used by KH18 averaged only 0.85 observations per month, and 82% of these months had no observations at all. Given the heterogeneous nature of SST at local and regional levels, using such broad-scale data as ERSST, is likely to produce substantial errors at reef scales (Figure 1A, red line prior to 1900)

Rebuilding relationships on coral reefs: Coral bleaching knowledge-sharing to aid adaptation planning for reef users: Bleaching emergence on reefs demonstrates the need to consider reef scale and accessibility when preparing for, and responding to, coral bleaching

Coral bleaching has impacted reefs worldwide and the predictions of near-annual bleaching from over two decades ago have now been realized. While technology currently provides the means to predict large-scale bleaching, predicting reef-scale and within-reef patterns in real-time for all reef users is limited. In 2020, heat stress across the Great Barrier Reef underpinned the region's third bleaching event in 5 years. Here we review the heterogeneous emergence of bleaching across Heron Island reef habitats and discuss the oceanographic drivers that underpinned variable bleaching emergence. We do so as a case study to highlight how reef end-user groups who engage with coral reefs in different ways require targeted guidance for how, and when, to alter their use of coral reefs in response to bleaching events. Our case study of coral bleaching emergence demonstrates how within-reef scale nowcasting of coral bleaching could aid the development of accessible and equitable bleaching response strategies on coral reefs. Also see the video abstract here: https://youtu.be/N9Tgb8N-vN0

Developing and validating a prediction model of adolescent major depressive disorder in the offspring of depressed parents

Background: Parental depression is common and is a major risk factor for depression in adolescents. Early identification of adolescents at elevated risk of developing major depressive disorder (MDD) in this group could improve early access to preventive interventions. Methods: Using longitudinal data from 337 adolescents at high familial risk of depression, we developed a risk prediction model for adolescent MDD. The model was externally validated in an independent cohort of 1,384 adolescents at high familial risk. We assessed predictors at baseline and MDD at follow‐up (a median of 2–3 years later). We compared the risk prediction model to a simple comparison model based on screening for depressive symptoms. Decision curve analysis was used to identify which model‐predicted risk score thresholds were associated with the greatest clinical benefit. Results: The MDD risk prediction model discriminated between those adolescents who did and did not develop MDD in the development (C‐statistic = .783, IQR (interquartile range) = .779, .778) and the validation samples (C‐statistic = .722, IQR = −.694, .741). Calibration in the validation sample was good to excellent (calibration intercept = .011, C‐slope = .851). The MDD risk prediction model was superior to the simple comparison model where discrimination was no better than chance (C‐statistic = .544, IQR = .536, .572). Decision curve analysis found that the highest clinical utility was at the lowest risk score thresholds (0.01–0.05). Conclusions: The developed risk prediction model successfully discriminated adolescents who developed MDD from those who did not. In practice, this model could be further developed with user involvement into a tool to target individuals for low‐intensity, selective preventive intervention

Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review

Diseases diagnosed in adulthood may have antecedents throughout (including prenatal) life. Gaining a better understanding of how exposures at different stages in the lifecourse influence health outcomes is key to elucidating the potential benefits of disease prevention strategies. Mendelian randomisation (MR) is increasingly used to estimate causal effects of exposures across the lifecourse on later life outcomes. This systematic literature review explores MR methods used to perform lifecourse investigations and reviews previous work that has utilised MR to elucidate the effects of factors acting at different stages of the lifecourse. We conducted searches in PubMed, Embase, Medline and MedRXiv databases. Thirteen methodological studies were identified. Four studies focused on the impact of time-varying exposures in the interpretation of "standard" MR techniques, five presented methods for repeat measures of the same exposure, and four described methodological approaches to handling multigenerational exposures. A further 127 studies presented the results of an applied research question. Over half of these estimated effects in a single generation and were largely confined to the exploration of questions regarding body composition. The remaining mostly estimated maternal effects. There is a growing body of research focused on the development and application of MR methods to address lifecourse research questions. The underlying assumptions require careful consideration and the interpretation of results rely on select conditions. Whilst we do not advocate for a particular strategy, we encourage practitioners to make informed decisions on how to approach a research question in this field with a solid understanding of the limitations present and how these may be affected by the research question, modelling approach, instrument selection, and data availability

Emotional problems across development: examining measurement invariance across childhood, adolescence and early adulthood

Emotional problems (anxiety, depression) are prevalent in children, adolescents and young adults with varying ages at onset. Studying developmental changes in emotional problems requires repeated assessments using the same or equivalent measures. The parent-rated Strengths and Difficulties Questionnaire is commonly used to assess emotional problems in childhood and adolescence, but there is limited research about whether it captures a similar construct across these developmental periods. Our study addressed this by investigating measurement invariance in the scales’ emotional problems subscale (SDQ-EP) across childhood, adolescence and early adulthood. Data from two UK population cohorts were utilised: the Millennium Cohort Study (ages 3–17 years) and the Avon Longitudinal Study of Parents and Children (4–25 years). In both samples we observed weak (metric) measurement invariance by age, suggesting that the parent-rated SDQ-EP items contribute to the underlying construct of emotional problems similarly across age. This supports the validity of using the subscale to rank participants on their levels of emotional problems in childhood, adolescence and early adulthood. However strong (scalar) measurement invariance was not observed, suggesting that the same score may correspond to different levels of emotional problems across developmental periods. Comparisons of mean parent-rated SDQ-EP scores across age may therefore not be valid