Preventing male suicide through a psychosocial intervention that provides psychological support and tackles financial difficulties:a mixed method evaluation

BACKGROUND: To help resolve high suicide rates in Bristol, North Somerset and South Gloucestershire, the charity Second Step was commissioned to roll-out the Hope service offering a psychosocial intervention for men, supporting them through acute distress and addressing financial difficulties. This study evaluated the impact of the Hope service on men at risk of suicide experiencing financial and other difficulties. METHODS: Mixed methods study using: (i) a prospective cohort study design to compare depression, suicidal ideation and financial self-efficacy scores of men aged 30–64, referred to the service between October 2018 and July 2020, at baseline and 6 months follow-up and between low and moderate to high-intensity service users; and (ii) a qualitative interview study to evaluate the acceptability and impact of the Hope service to Hope service users. RESULTS: There was a 49% reduction in depression score (mean reduction − 10.0, 95% CI − 11.7 to − 8.3) and in the proportion of service users with suicidal ideation (percent reduction − 52.5, 95% CI − 64.1% to − 40.9%) at 6 months follow-up compared to baseline. Financial self-efficacy scores increased by 26% (mean increase 2.9, 95% CI 1.8 to 3.9). Qualitative accounts illustrated how ‘Hope saved my life’ for several men interviewed; most respondents described being able to move forward and tackle challenges with more confidence following the Hope intervention. Professional advice to tackle financial and other difficulties such as housing helped to relieve anxiety and stress and enable practical issues to be resolved. CONCLUSIONS: The Hope service offered practical and emotional support to men who have experienced suicidal feelings, redundancy, homelessness and poverty and occupies an important space between mental health and social care provision. Hope demonstrates the value of an intervention which cuts across traditional boundaries between psychiatric care and social advice agencies to provide, what is, in effect, an integrated care service. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-022-03973-5

Interventions for preventing or treating malnutrition in homeless problem-drinkers:a systematic review

Abstract Background Excessive drinking leads to poor absorption of nutrients and homeless problem-drinkers often have nutritionally inadequate diets. Depletion of nutrients such as vitamin B1 can lead to cognitive impairment, which can hinder efforts to reduce drinking or engage with services. This review aimed to assess effectiveness of interventions designed to prevent or treat malnutrition in homeless problem-drinkers. Methods We systematically searched nine electronic databases and 13 grey literature sources for studies evaluating interventions to improve nutrition in homeless populations, without regional or language restrictions. Screening for inclusion was done in duplicate. One reviewer extracted data and assessed risk of bias, and another checked the extractions. Primary outcomes were nutrition status/deficiency, liver damage, and cognitive function. Secondary outcomes included abstinence, comorbidities, resource use, acceptability and engagement with intervention. Results were synthesised narratively. Results We included 25 studies (2 Randomised Controlled Trials; 15 uncontrolled before and after; 7 surveys; 1 case-control). Nine studies evaluated educational and support interventions, five food provision, and three supplement provision. Eight studies evaluated a combination of these interventions. No two interventions were the same, and all studies were at high risk of bias. Nutritional status (intake/ deficiency) were reported in 11 studies and liver function in one. Fruit and vegetable intake improved with some education and support interventions (n = 4 studies) but not others (n = 2). Vitamin supplements appeared to improve vitamin deficiency levels in the blood (n = 2). Free or subsidised meals (n = 4) and food packs (n = 1) did not always fulfil dietary needs, but were usually considered acceptable by users. Some multicomponent interventions improved nutrition (n = 3) but acceptability varied (n = 3). No study reported cost effectiveness. Conclusions The evidence for any one intervention for improving malnutrition in homeless problem-drinkers was based on single studies at high risk of bias. Various food and supplement provision interventions appear effective in changing nutritional status in single studies. Educational and multicomponent interventions show improved nutritional behaviour in some studies but not others. Further better quality evidence is required before these interventions can be recommended for implementation. Any future studies should seek the end user input in their design and conduct. Trial registration Registered with PROSPERO: CRD42015024247

Birth and early life influences on child and adolescent health

This thesis consists of two sections: section I - mode of birth delivery and asthma in childhood; and section II - sleep duration and obesity in adolescents. Section I - Prevalence of paediatric asthma has increased significantly over the past two decades. Parallel to this increase, rates of caesarean section have also risen considerably. Current updates made to the National Institute for Health and Care Excellence guidelines facilitate the uptake of elective caesarean sections which may impact on the prevalence of childhood asthma in the UK. This section compromises; (I) a systematic review and meta-analysis of the association between caesarean section and asthma in childhood. A 23% increase in •the subsequent risk of asthma in children delivered by caesarean section was shown; (II) a study investigating the association between the different methods of delivery and the development of childhood asthma was conducted through the use of birth and childhood data from the UK Millennium Cohort. A consistent association between caesarean section, asthma and its symptoms was shown. Section II - The rise in childhood and adolescent obesity occurred contemporaneously with a / decrease in usual hours of sleep, thus suggesting a potential link. This section compromise; (Ill) a study investigating the association between sleep duration and weight related parameters in Northern Irish adolescents through the use of cross-sectional data from the Young Hearts 2000 study . . A strong inverse association was found between average sleep duration and all weight related parameters; (IV) a study investigating the association between sleep duration and weight related parameters in Malaysian adolescents was conducted through the use of prospective cohort data from the MyHearts study. Inverse association was found between average sleep duration and most of the weight related parameters investigatedEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses.

OBJECTIVES: To determine the effects of low-to-moderate levels of maternal alcohol consumption in pregnancy on pregnancy and longer-term offspring outcomes. SEARCH STRATEGY: Medline, Embase, Web of Science and Psychinfo from inception to 11 July 2016. SELECTION CRITERIA: Prospective observational studies, negative control and quasiexperimental studies of pregnant women estimating effects of light drinking in pregnancy (≤32 g/week) versus abstaining. Pregnancy outcomes such as birth weight and features of fetal alcohol syndrome were examined. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and another checked extracted data. Random effects meta-analyses were performed where applicable, and a narrative summary of findings was carried out otherwise. MAIN RESULTS: 24 cohort and two quasiexperimental studies were included. With the exception of birth size and gestational age, there was insufficient data to meta-analyse or make robust conclusions. Odds of small for gestational age (SGA) and preterm birth were higher for babies whose mothers consumed up to 32 g/week versus none, but estimates for preterm birth were also compatible with no association: summary OR 1.08, 95% CI (1.02 to 1.14), I(2) 0%, (seven studies, all estimates were adjusted) OR 1.10, 95% CI (0.95 to 1.28), I(2) 60%, (nine studies, includes one unadjusted estimates), respectively. The earliest time points of exposure were used in the analysis. CONCLUSION: Evidence of the effects of drinking ≤32 g/week in pregnancy is sparse. As there was some evidence that even light prenatal alcohol consumption is associated with being SGA and preterm delivery, guidance could advise abstention as a precautionary principle but should explain the paucity of evidence