Understanding and Promoting Help-Seeking Behaviour for Mental Health Difficulties in Young People: A Qualitative Study

Despite mental health difficulties being common and accounting for the highest disease burden in young people, they often do not seek help or support for these difficulties. This thesis focuses on exploring the mental health difficulties and help-seeking behaviour of young people. Part 1 is a systematic review of the literature on time trends in the prevalence of mental health difficulties in young people. Four published studies and four national epidemiological surveys are included in the review. The findings suggest an increase in the burden of reported common mental health difficulties in both males and females over the past 30 years. Various socio-cultural and economic factors such as increased social inequality, internet use, and educational pressures, are suggested to have contributed to the observed increases. However, additional research is needed to explore these further. Part 2 reports a qualitative study exploring, from the perspective of young people, the facilitators and barriers to help-seeking and the potential ways in which an online intervention could support and promote their decisions to seek help. A thematic analysis identified 11 themes within the domains of: socio-cultural ambivalence surrounding mental health, the personal help-seeking process, and online messages and prompts to overcome barriers and support help-seeking. Finally, Part 3 presents a discussion of how the researcher shaped and was shaped by the research process and findings as well as an exploration of the challenging narratives observed in the data

Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial

Background Cannabis is the most commonly used illicit substance among people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. Methods CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at last one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. Results: 551 participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99,382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group, however the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. Conclusions Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Can counter-stereotypes boost flexible thinking?

To reduce prejudice psychologists design interventions requiring people to think of counter-stereotypes (i.e., people who defy stereotypic expectations—a strong woman, a Black President). Grounded in the idea that stereotypes constrain the ability to think flexibly, we propose that thinking of counter-stereotypes can have benefits that extend beyond the goal of prejudice reduction—in particular to tasks measuring cognitive flexibility and creative performance. Findings supported this conjecture. In Experiment 1 priming a gender counter-stereotype enhanced cognitive flexibility. This effect could not be attributed to changes in mood. In Experiment 2, using a gender-independent manipulation, priming various social counter-stereotypes brought a boost to creative performance. We discuss implications of these extended benefits of counter-stereotypic thinking for developing future prejudice-reduction interventions

The Early Youth Engagement (EYE) project: A feasibility and pilot study to promote better engagement and outcomes in first episode psychosis

Background: Engagement with Early Intervention in Psychosis (EIP) services improves symptoms, illness course, social and occupational function, yet, 25-30% of patients disengage from services within the first 12 months. This study aimed to develop an intervention to promote better youth engagement and health outcomes for this population.Method: First, a cross-sectional qualitative study investigated facilitators and barriers to engagement from the perspective of EIP service users, their relatives and healthy young people. Forty focus groups/ interviews were conducted with 68 participants, and thematic analysis was applied to the transcribed data. Next, a Delphi consultation with 27 clinicians, managers and experts, reached consensus on a set of pragmatic, deliverable service adaptations which formed the new Early Youth Engagement (EYE) service model. Finally, 298 first episode psychosis services users received either the original model (pre-adaptation) or the EYE model (post-adaptation), and both engagement at 12 months, and feasibility and satisfaction were explored.Results: A generalized linear model with engagement status nested within teams, revealed that the proportion disengaged was significantly lower in the EYE model cohort. Engagement was not predicted by team, age or gender. Disengagement decreased from 24% prior to 14.5% post the intervention. Qualitative feedback revealed impacts on communication, social involvement, staff approaches, collaboration, practical goals, hope and trust.Conclusion: This study demonstrates how a new early youth engagement model might reduce drop out, and promote satisfaction and better social and health outcomes for this sub-group of young people at risk of disengagement.</p