Development of the revised WHOQOL-BREF Quality of Life Assessment: towards a mediation model on quality of life and post-traumatic stress

The adverse consequences of posttraumatic stress on quality of life have been well documented. It is, however, possible that it is not the intrusive re-experiencing and hyperarousal posttraumatic stress symptoms that have an impact on quality of life per se, but the inflexible efforts to avoid internal experiences and emotions related to the traumatic event, and the way these emotions are expressed and experienced. Previous research shows that both experiential avoidance and emotion regulation have been found to be etiologically central to the development and maintenance of psychological problems in trauma survivors. The degree to which experiential avoidance and emotion regulation act together as toxic underlying mechanisms to explain the relationship between posttraumatic stress and quality of life is, however, yet to be examined. Quality of life is now regarded as an important outcome variable across a broad range of conditions and problem areas. The quality of life concept has generated a large body of research and yet its assessment has been a challenge for researchers. The WHOQOL-BREF is considered to be one of the few genuine quality of life measures but it has received much criticism, especially regarding the poor psychometric performance of its social relationships domain. The aim of the current thesis was twofold. The first aim involved the revision of the WHOQOL-BREF through the enhancement of the social relationships domain. In Study I 986 ill and healthy individuals from five countries worldwide completed the Pilot Revised WHOQOL-BREF (WHOQOL-BREF-R) along with measures of life satisfaction, anxiety, and depression for the detailed psychometric analysis of the scale. Study I confirmed the limitations of the social relationships domain, and despite its improvement, the performance of the overall scale was found to be poor. In fact, findings from modern and robust techniques challenged the 4-factor structure of the WHOQOL-BREF. Instead, results supported the performance of a 3-factor solution, which led to the development of a psychometrically sound measure. Study II is preceded by a systematic review of the literature investigating experiential avoidance as a mediator in trauma survivors with posttraumatic stress. Ten studies were identified and organised in two categories assessing experiential avoidance as a mediator between: 1) trauma exposure and posttraumatic stress, and 2) posttraumatic stress and maladaptive behaviours. Findings suggest that the development and maintenance of posttraumatic stress symptoms and maladaptive behaviours in the aftermath of trauma can be explained through the use of experiential avoidance. Methodological limitations and future directions for research are discussed. The WHOQOL-BREF-R was then used in Study II, which explored an integrative mediation model whereby experiential avoidance and emotion regulation were tested as mediators in the relationship between posttraumatic stress symptomatology and quality of life in trauma exposed adults. The two mediators were also explored for their overlapping relationship. A total of 360 participants from the community completed self-report measures of posttraumatic stress, experiential avoidance, emotion regulation, and quality of life. With the use of path analysis Study II found experiential avoidance and emotion regulation to be two distinct constructs that together act as an underlying mechanism explaining the impact of posttraumatic stress on quality of life. Alternative mediating models were explored. The current study makes an important contribution in the area of trauma and in the conceptualisation and assessment of quality of life. Findings can be considered as a first step towards an integrative mediation model of toxic mechanisms in trauma and quality of life. Additionally, the favourable psychometric properties of the WHOQOL-BREF-R make it a powerful tool for use in quality of life research

Design and Validation of the Primary-Secondary School Transitions Emotional Wellbeing Scale (P-S WELLS); the First Scale to Assess Children’s Emotional Wellbeing in the Context of Primary-Secondary School Transitions

Children with poor emotional wellbeing and mental health, following primary-secondary school transitions, are more likely to experience increased educational disruption, poor academic attainment, and social maladjustment, which can lead to poor life chances and exacerbate existing social inequalities. However, the corpus of scales used to assess primary-secondary school transitions and emotional wellbeing during this time have considerable limitations, which has significant consequences for identifying and supporting children’s emotional wellbeing at this critical juncture.Outlined is a protocol for the design and validation of the first robust, sensitive, and standardised accessible scale, to longitudinally assess children’s emotional wellbeing in the context of primary-secondary school transitions. This brief and accessible scale will be named the Primary-Secondary School Transitions Emotional Wellbeing Scale (P-S WELLS). P-S WELLS will be developed following a multi-informant, mixed-methods model of scale development, which we outline to facilitate transparent reporting.The lack of a standardised, robust, sensitive, and accessible quantitative scale to assess children’s emotional wellbeing, over time and in the context of primary-secondary school transitions, is inhibiting empirical progress within the field, our ability to best support children in practice, and likely leading to policies and practices that are not fit for purpose. P-S WELLS and its development will be novel in its (a) approach, in that we will ask children about their feelings towards the changes they are negotiating in context; (b) use longitudinal design and operationalisation; and (c) aim to overcome limitations found in previous work

Cumulative risk exposure and emotional symptoms among early adolescent girls

From Springer Nature via Jisc Publications RouterHistory: received 2020-10-10, accepted 2021-10-28, registration 2021-10-29, pub-electronic 2021-11-05, online 2021-11-05, collection 2021-12Publication status: PublishedFunder: National Lottery Community Fund; doi: http://dx.doi.org/10.13039/501100000385Abstract: Background: From early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls. Methods: We used secondary data analysis, drawing on data capturing demographic information and self-reported emotional symptoms from 8327 girls aged 11–12 years from the 2017 baseline data collection phase of the HeadStart evaluation. We used structural equation modelling to identify risk factors in relation to self-reported emotional symptoms, and collated this into a CRE index to investigate associations between CRE and emotional symptoms. Results: Four risk factors were found to have a statistically significant relationship with emotional symptoms among early adolescent girls: low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with emotional symptoms, with a small effect size. Conclusions: Results identify risk factors (outlined above) that are associated with emotional symptoms among early adolescent girls, and highlight that early adolescent girls experiencing a greater number of risk factors in their lives are likely to also experience greater emotional distress. Findings highlight the need for identification and targeted mental health intervention (e.g., individual or group counselling, approaches targeting specific symptoms), for those facing greater risk and/or with emergent symptoms

The role of school connectedness and friend contact in adolescent loneliness, and implications for physical health

JI was supported by the Medical Research Council (MC_UU_00022/1) and the Scottish Government Chief Scientist Office (SPHSU16). The HBSC 2013/14 study in Scotland was funded by NHS Health Scotland (now Public Health Scotland).The current study investigated how adolescents' loneliness relates to school connectedness, classmate support, teacher support, and offline and online communication with friends. We also examined the association between loneliness, physical health, and sleep. Data came from the Scottish Health Behavior in School-aged Children (HBSC). The total sample was 2983 adolescents (F = 1479 [49.6%]) aged 14-17 years (M = 15.66, SD = 0.39) from 117 secondary schools in Scotland. Results showed that (1) higher teacher support, classmate support, and offline contact with friends predicted lower levels of loneliness, (2) online friendship engagement predicted higher levels of loneliness, and (3) poor health and sleep were positively associated with loneliness. The study offers new findings, highlighting the role played by classmates/peers and teachers in reducing loneliness. Supporting previous research, we also found associations between loneliness, poor sleep, and worse physical health.Publisher PDFPeer reviewe

Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis

BACKGROUND:In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.AIMS:To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.METHOD:We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.RESULTS:We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR = 0.59, 95% CI 0.35-1.02), with a number needed to treat of approximately 10 (95% CI 5-?). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.CONCLUSIONS:For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required

Examining the impact of a universal social and emotional learning intervention (Passport) on internalising symptoms and other outcomes among children, compared to the usual school curriculum: study protocol for a school-based cluster randomised trial.

Background: School-based universal social and emotional learning (SEL) interventions implemented during the transition to adolescence may be efficacious in preventing the development of mental health difficulties. This protocol describes a two-arm parallel cluster randomised controlled trial to investigate the impact of a universal SEL intervention (Passport, compared to usual provision) on internalising symptoms (primary outcome), emotion regulation, well-being, loneliness, social support, bullying, academic attainment, and health-related quality of life in English primary school pupils aged 9-11 years. A developer-led trial demonstrated the feasibility, acceptability, and utility of Passport; this will be the first independent trial.Methods: Sixty primary schools will be recruited across the Greater Manchester city region and surrounding areas, involving 2400 pupils aged 8-9 at baseline. Schools will be allocated to the intervention arm to implement Passport over 18 weekly sessions or to the control arm to implement the usual school curriculum. Random allocation will be at school level following completion of baseline measures, with minimisation to ensure balance across trial arms in school size and free school meal eligibility. Measures will be collected at baseline, post-intervention (12 months post-baseline), and at 12 months follow-up (24 months post-baseline). The primary outcome analysis (intervention effects on internalising symptoms at post-intervention) will comprise a two-level (school, child) hierarchical linear model, following the intention-to-treat principle. Additional analyses will be undertaken to assess intervention effects on secondary outcomes, maintenance effects for all outcomes, intervention compliance moderator effects, subgroup moderator effects, and mechanisms underpinning intervention effects on the primary outcome. A mixed-methods implementation and process evaluation will examine factors that influence implementation, and a health economic evaluation will assess the cost-effectiveness of the intervention.Discussion: Findings will provide educators with crucial knowledge of whether and how increasing emotion regulation through a universal intervention impacts internalising symptoms and a range of related outcomes. Findings will also inform policy related to the promotion of mental health among children and young people. If the intervention is found to be efficacious in reducing internalising symptoms and is also cost-effective, it may offer high potential as a preventative intervention for widespread implementation.Trial Registration: ISRCTN12875599; registered on 24 November 2022.</p

Examining the impact of a universal social and emotional learning intervention (Passport) on internalising symptoms and other outcomes among children, compared to the usual school curriculum:study protocol for a school-based cluster randomised trial

BACKGROUND: School-based universal social and emotional learning (SEL) interventions implemented during the transition to adolescence may be efficacious in preventing the development of mental health difficulties. This protocol describes a two-arm parallel cluster randomised controlled trial to investigate the impact of a universal SEL intervention (Passport, compared to usual provision) on internalising symptoms (primary outcome), emotion regulation, well-being, loneliness, social support, bullying, academic attainment, and health-related quality of life in English primary school pupils aged 9-11 years. A developer-led trial demonstrated the feasibility, acceptability, and utility of Passport; this will be the first independent trial.METHODS: Sixty primary schools will be recruited across the Greater Manchester city region and surrounding areas, involving 2400 pupils aged 8-9 at baseline. Schools will be allocated to the intervention arm to implement Passport over 18 weekly sessions or to the control arm to implement the usual school curriculum. Random allocation will be at school level following completion of baseline measures, with minimisation to ensure balance across trial arms in school size and free school meal eligibility. Measures will be collected at baseline, post-intervention (12 months post-baseline), and at 12 months follow-up (24 months post-baseline). The primary outcome analysis (intervention effects on internalising symptoms at post-intervention) will comprise a two-level (school, child) hierarchical linear model, following the intention-to-treat principle. Additional analyses will be undertaken to assess intervention effects on secondary outcomes, maintenance effects for all outcomes, intervention compliance moderator effects, subgroup moderator effects, and mechanisms underpinning intervention effects on the primary outcome. A mixed-methods implementation and process evaluation will examine factors that influence implementation, and a health economic evaluation will assess the cost-effectiveness of the intervention.DISCUSSION: Findings will provide educators with crucial knowledge of whether and how increasing emotion regulation through a universal intervention impacts internalising symptoms and a range of related outcomes. Findings will also inform policy related to the promotion of mental health among children and young people. If the intervention is found to be efficacious in reducing internalising symptoms and is also cost-effective, it may offer high potential as a preventative intervention for widespread implementation.TRIAL REGISTRATION: ISRCTN12875599; registered on 24 November 2022.</p

The Factor Structure of the 4-Item Perceived Stress Scale in English Adolescents

This study investigated the factor structure, internal consistency, and known-groups validity of the 4-item Perceived Stress Scale in a large sample of 29,388 English adolescents. Results indicated that the original unidimensional structure was not viable and instead provided support for a two-factor structure. Examination of a bifactor-(S − 1) model indicated that this multidimensionality can be attributed to reverse-worded items; however, beyond method effects, these factors appear to capture distinct, though inter-related, constructs. As this multidimensional structure relies on 2-item factors, we advise use of longer versions of this measure where possible