Asthma, caregiving and mental health:the mind keeps the score

This thesis includes a systematic literature review, a research outcome paper and a critical appraisal. The systematic literature review summarises 20 outcome papers that explore the use of Mentalisation-Based Treatment (MBT) in participants with different mental health presentations. The results suggest that MBT has strong evidence in the treatment of people with a diagnosis of Borderline Personality Disorder (BPD) and that MBT has the potential of improving clinical outcomes in people with diagnoses of eating disorders and depression, adolescents who self-harm and mothers enrolled in substance misuse treatments. As compared to other interventions, MBT yielded positive outcomes that were maintained over long follow-ups and thus should be increasingly available for people with a diagnosis of BPD. Future research addressing treatment fidelity, confounding and assessor‘s blindness bias is required. The outcome paper explores the mental health of adult caregivers of asthmatic children living in the United Kingdom. Using an online designed questionnaire, the study collected information regarding participants´ socio-demographic characteristics, mentalising ability, family functioning, anxiety, depression and hypomanic symptoms. The aim was to further explore the association between caregivers´mentalising capacity and self-reported mental health symptoms. Sequential linear regression models showed that mentalising on its own was associated with 16%, and 14% of depressive and anxiety symptoms respectively. On the contrary, family functioning was not significantly associated with the independent variables in any of the regression models after mentalising was included. Psychological interventions targeting mentalising might be helpful in reducing anxiety and depression symptoms in this population. The critical appraisal includes the author´s personal reflections on the journey of writing a doctorate thesis along with the implications of the findings

The regional geography of alcohol consumption in England:comparing drinking frequency and binge drinking

Alcohol consumption frequency and volume are known to be related to health problems among drinkers. Most of the existing literature that analyses regional variation in drinking behaviour uses measures of consumption that relate only to volume, such as ’binge drinking’. This study compares the regional association of alcohol consumption using measures of drinking frequency (daily drinking) and volume (binge drinking) using a nationally representative sample of residents using the Health Survey for England, 2011–2013. Results suggest the presence of two differentiated drinking patterns with relevant policy implications. We find that people in northern regions are more likely to binge drink, whereas people in southern regions are more likely to drink on most days. Regression analysis shows that regional variation in binge drinking remains strong when taking into account individual and neighbourhood level controls. The findings provide support for regional targeting of interventions that aim to reduce the frequency as well as volume of drinking

Examining the Association Between Mentalizing and Parental Mental Health in a Sample of Caregivers of Children with Asthma

Background: Caregivers of children with asthma are at higher risk of experiencing mental health difficulties and lower quality of life than caregivers of healthy children. Mentalizing is a psychological construct that defines the ability of understanding one’s own and others’ states of mind. Poor levels of mentalizing are strongly associated with a wide range of mental health difficulties such as depression, anxiety or emotional dysregulation. This cross-sectional study is the first to examine the associations between mentalizing and mental health in a sample of caregivers of children with asthma. Method: Caregivers of children (mean age=6.53, SD=3.72, ages 1 to 17) with asthma were recruited from social media support groups and the Asthma UK charity research bulletin. Participants completed self report measures of mentalizing, family functioning, mood and anxiety difficulties. Results: A total of 88 caregivers completed the full survey. Results indicated that poorer mentalizing capacity was significantly associated with poorer family functioning and increased mood and anxiety symptomatology. Poor mentalizing was significantly associated with increased levels of depression, hypomania and anxiety, explaining 16% of variance in depression and 10% of variance in anxiety. Family functioning was not a significant predictor after controlling for the effect of mentalizing. Conclusions: These findings suggest that mentalizing capacity might be a valued new treatment target to improve the mental health of caregivers of children with asthma. The results suggest that mentalizing could complement previously identified factors such as family functioning or asthma symptom severity in understanding caregivers’ mental health. Further investigation into the role of mentalizing in the mental health of this population is warranted

Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures. This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy. The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP. The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted

The complexity of treatment-resistant depression: A data-driven approach

Background - Recent systematic reviews highlight great variability in defining and assessing treatment-resistant depression (TRD). A key problem is that definitions are consensus rather than data-led. This study seeks to offer a comprehensive socio-demographic and clinical description of a relevant sample. Methods - As part of a pragmatic randomized controlled trial, patients (N = 129) were managed in primary care for persistent depression and diagnosed with TRD. Data included previous treatment attempts, characteristics of the depressive illness, functioning, quality of life, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events. Results - Findings show a severe and chronic course of depression with a duration of illness of 25+ years. Overall, 82.9 % had at least one other psychiatric diagnosis and 82.2 % at least one personality disorder; 69.8 % had significant musculoskeletal, gastrointestinal, genitourinary, or cardiovascular and respiratory physical health problems. All but 14 had severe difficulties in social and occupational functioning and reported severely impaired quality of life. Suicidal ideation was high: 44.9 % had made at least one serious suicide attempt and several reported multiple attempts with 17.8 % reporting a suicide attempt during childhood or adolescence. Of the patients, 79.8 % reported at least one adverse childhood experience. Limitations - Potential for recall bias, not examining possible interactions, and absence of a control group. Conclusions - Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences. Individuals with TRD may be at a serious disadvantage in terms of receiving adequate treatment

Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures:a pilot study

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted

The Complexity of Treatment-Resistant Depression: A Data-driven Approach

Background: Recent systematic reviews highlight great variability in defining and assessing treatment-resistant depression (TRD). A key problem is that definitions are consensus rather than data-led. This study seeks to offer a comprehensive socio-demographic and clinical description of a relevant sample. Methods: As part of a pragmatic randomized controlled trial, patients (N = 129) were managed in primary care for persistent depression and diagnosed with TRD. Data included previous treatment attempts, characteristics of the depressive illness, functioning, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events. Results: Findings show a severe and chronic course of depression with a duration of illness of 25+ years. Overall, 82.9% had at least one other psychiatric diagnosis and 82.2% at least one personality disorder; 69.8% had significant musculoskeletal, gastrointestinal, genitourinary, or cardiovascular and respiratory physical health problems. All but 14 had severe difficulties in social and occupational functioning and reported severely impaired quality of life. Suicidal ideation was high: 44.9% had made at least one serious suicide attempt and several reported multiple attempts with 17.8% reporting a suicide attempt during childhood or adolescence. Of the patients, 79.8% reported at least one adverse childhood experience. Limitations: Potential for recall bias, not examining possible interactions, and absence of a control group. Conclusions: Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences. Individuals with TRD may be at a serious disadvantage in terms of receiving adequate treatment.</br