Mental health and well-being of fathers of children with intellectual disabilities: systematic review and meta-analysis

BACKGROUND: Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers. AIMS: The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population. METHOD: A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria. RESULTS: Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10). CONCLUSIONS: There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population

Guided self-help cognitive behavioural therapy for depression in primary care : a randomised controlled trial

Peer reviewedPublisher PD

The impact of dark matter cusps and cores on the satellite galaxy population around spiral galaxies

We use N-body simulations to study the effects that a divergent (i.e. ‘cuspy') dark matter profile introduces on the tidal evolution of dwarf spheroidal galaxies (dSphs). Our models assume cosmologically motivated initial conditions where dSphs are dark-matter-dominated systems on eccentric orbits about a host galaxy composed of a dark halo and a baryonic disc. We find that the resilience of dSphs to tidal stripping is extremely sensitive to the cuspiness of the inner halo profile; whereas dwarfs with a cored profile can be easily destroyed by the disc component, those with cusps always retain a bound remnant, even after losing more than 99.99 per cent of the original mass. For a given halo profile, the evolution of the structural parameters as driven by tides is controlled solely by the total amount of mass lost. This information is used to construct a semi-analytic code that follows the tidal evolution of individual satellites as they fall into a more massive host, which allows us to simulate the hierarchical build-up of spiral galaxies assuming different halo profiles and disc masses. We find that tidal encounters with discs tend to decrease the average mass of satellite galaxies at all galactocentric radii. Of all satellites, those accreted before re-ionization (z≳ 6), which may be singled out by anomalous metallicity patterns, provide the strongest constraints on the inner profile of dark haloes. These galaxies move on orbits that penetrate the disc repeatedly and survive to the present day only if haloes have an inner density cusp. We show that the size-mass relationship established from Milky Way (MW) dwarfs strongly supports the presence of cusps in the majority of these systems, as cored models systematically underestimate the masses of the known ultra-faint dSphs. Our models also indicate that a massive M31 disc may explain why many of its dSphs with suitable kinematic data fall below the size-mass relationship derived from MW dSphs. We also examine whether our modelling can constrain the mass threshold below which star formation is suppressed in dark matter haloes. We find that luminous satellites must be accreted with masses above 108-109 M⊙ in order to explain the size-mass relation observed in MW dwarf

Community-based group guided self-help intervention for low mood and stress: randomised controlled trial

Background: To date no studies have explored the effectiveness of written cognitive–behavioural therapy (CBT) resources for low mood and stress delivered via a course of self-help classes in a community setting. Aims: To assess the effectiveness of an 8-week community-based CBT self-help group classes on symptoms of depression, anxiety and social function at 6 months (trial registration: ISRCTN86292664). Method: In total, 142 participants were randomly allocated to immediate (n = 71) or delayed access to a low-intensity CBT intervention (n = 71). Measures of depression, anxiety and social function were collected at baseline and 6 months. Results: There was a significant improvement for the primary outcome of Patient Health Questionnaire-9 (PHQ-9) score (mean betweengroup difference: –3.64, 95% CI –6.06 to –1.23; P = 0.004). The percentage of participants reducing their PHQ-9 score between baseline and 6 months by 50% or more was 17.9% for the delayed access group and 43.8% for the immediate access group. Secondary outcomes also improved including anxiety and social function. The intervention was cost neutral. The probabilities of a net benefit at willingness to pay thresholds of £20 000, £25 000 or £30 000 were 0.928, 0.944 and 0.955, respectively. Conclusions: Low-intensity class-based CBT delivered within a community setting is effective for reducing depression, anxiety and impaired social function at little additional cost

Autism and attachment disorder symptoms in the general population : Prevalence, overlap, and burden

Acknowledgements: This work was supported by the Chief Scientist Office of the Scottish Government (CZG/2/565) and the Gillberg Neuropsychiatry Centre. We are grateful to all of the participants and to the Growing up in Scotland team for their support with this study. Funding: The author(s) received no financial support for the research, authorship, and/or publication of this articlePeer reviewedPublisher PD

BEAT-IT:comparing a behavioural activation treatment for depression in adults with intellectual disabilities with an attention control : study protocol for a randomised controlled trial

BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice. TRIAL REGISTRATION: Date trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005

The ISLANDS project I: Andromeda XVI, An Extremely Low Mass Galaxy not Quenched by Reionization

Based on data aquired in 13 orbits of HST time, we present a detailed evolutionary history of the M31 dSph satellite Andromeda XVI, including its life-time star formation history, the spatial distribution of its stellar populations, and the properties of its variable stars. And XVI is characterized by prolonged star formation activity from the oldest epochs until star formation was quenched ~6 Gyr ago, and, notably, only half of the mass in stars of And XVI was in place 10 Gyr ago. And XVI appears to be a low mass galaxy for which the early quenching by either reionization or starburst feedback seems highly unlikely, and thus, is most likely due to an environmental effect (e.g., an interaction), possibly connected to a late infall in the densest regions of the Local Group. Studying the star formation history as a function of galactocentric radius, we detect a mild gradient in the star formation history: the star formation activity between 6 and 8 Gyr ago is significantly stronger in the central regions than in the external regions, although the quenching age appears to be the same, within 1 Gyr. We also report the discovery of 9 RR Lyrae stars, 8 of which belong to And XVI. The RR Lyrae stars allow a new estimate of the distance, (m-M)0= 23.72+/-0.09 mag, which is marginally larger than previous estimates based on the tip of the red giant branch.Comment: Accepted for publication on Ap

Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction

Aims: Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome. Methods: We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1–2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded. Results: 648 patients (n = 298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n = 350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.03% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased. Conclusions: In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon

Temperature-dependent performance and potential distribution of Pareuchaetes insulata, a biological control agent of Chromolaena odorata in South Africa

Despite the release of about 1.9 million individuals of Pareuchaetes insulata (Walker) (Lepidoptera: Erebidae) in KwaZulu-Natal for the biological control of Chromolaena odorata (L.) King and Robinson (Asteraceae) in South Africa, the moth probably only established at one of the 30 release sites and its population level is generally low in the field. To determine whether climate incompatibility in South Africa is responsible for the poor performance of P. insulata, the effects of temperature on life-history traits were investigated under several constant temperatures. Although a degree-day model estimated between 3.9 and 10.0 generations of the moth per year in the weed’s invaded range, survival and fecundity declined while development time was prolonged at constant temperatures below 25 °C, indicating that both direct and indirect negative impacts of low winter temperatures, such as increased mortality, slow development and reduced fecundity as well as exposure to natural enemies, may partly explain the poor performance of P. insulata in South Africa