Association between adverse childhood experiences and a combination of psychosis and violence among adults: a systematic review and meta-analysis

Relationships have been well established between adverse childhood experiences (ACEs) and later psychosis (29 systematic reviews) or violence (4 systematic reviews). To date, just one review has explored childhood maltreatment, specifically, and violence risk with psychosis. We conducted a systematic review and meta-analyses of a wider range of ACEs and later psychosis with actual violence compared with psychosis alone, violence alone or neither, completing searches in January 2021. In all, 15 studies met inclusion criteria, but only six included all four groups of interest. Two substantial studies recorded ACEs from sources independent of those affected and probably before emergent psychosis or violence; others relied on retrospective recall. Meta-analyses were possible only for within-psychosis-group comparisons; histories of physical abuse, sexual abuse, and having a criminal/violent parent or living with family alcohol/drug use were each associated with around twice the odds of psychosis with violence as psychosis alone. Although ACE measures in the four-way comparisons were too divergent for firm conclusions, abuse histories, and parental criminality emerged as likely antecedents, one study evidencing psychosis as mediating between ACEs and violence. Without longitudinal prospective study, pathways between ACEs and later problems remain unclear. Our findings add weight to the case for exploring ACEs in addition to abuse as possible indicators of later violence among people with psychosis and for trauma-informed interventions, which is important because some people are reluctant to disclose abuse histories

Young carers, mental health and psychosocial wellbeing: A realist synthesis

Growing evidence demonstrates that the mental and psychosocial health impacts of caring vary significantly for individual children, depending on who they are, the person that they care for, their responsibilities and the wider family situation. Although individual studies have made progress in identifying the range of impacts, there is a lack of clarity around which impacts affect who and in what circumstances. This synthesis, based on RAMESES realist protocols, aims to increase clarity concerning how and why the mental and psychosocial health impacts of caring for a family member vary for different children. There were 12 391 unique search results screened at title, abstract and full-paper levels. Forty-four retained studies were analysed, resulting in the development of a model with 17 context-mechanism-outcome configurations. The model divides the configurations into three interlinking domains. The caregiving responsibilities domain considers how the impacts of caring vary with the circumstances of the individual young carer, the person they care for and their family. The identity domain details the development of a caring identity that potentially mitigates the negative effects of caring and enables positive benefits. The support domain concerns the support provided from family, community and services that, depending on quality, can mitigate or exacerbate the impacts of caring. Support also moderates the care identity by affecting self-perception of the caring role. The model has the potential to inform the development of interventions that target particular mechanisms to enable positive change for young carers. This potential can be enhanced by further research to test the model, with a focus on refining configurations where less evidence is available. There is a particular need to focus on identification which is under-represented in the model as both a mechanism and a contextual factor due to unidentified young carers being largely absent from past researc

Prevalence of gambling behaviours and their associations with socioemotional harm among 11 to 16 year olds in Wales: findings from the School Health Research Network survey

Background: Gambling opportunities are increasingly available and acceptable to many adolescents. Adolescent problem gambling has been associated with poor outcomes, such as lower reported physical and mental health. While much research has focussed on ‘problem’ gambling, analysing the distribution and determinants of experimentation with gambling is important in order to understand its normalization and population level consequences. This study describes the distribution of inequalities and socioemotional harms associated with adolescent gambling. Methods: Data were drawn from a subsample of students (N = 37 363) who completed gambling questions as part of the 2017 School Health Research Network Student Health and Wellbeing Survey, representing 193 secondary schools in Wales. Using imputations, we estimated a series of single-predictor and multi-predictor regressions for count of gambling behaviours, any gambling in the past 12 months and socioemotional harms of gambling. Results: Approximately two-fifths (41.0%) of respondents reported gambling in the past 12 months, of whom 16.2% reported feeling bad as a result of their own gambling. We found significant sex differences in gambling, with boys gambling more frequently than girls. Adolescents from more affluent families reported a higher count of gambling behaviours and socioemotional harms, although paradoxically, increasing affluence was also associated with lower prevalence of gambling in the last year. Non-White British ethnicities and students who felt less connected to school were more likely to engage in gambling and experience socioemotional harms. Conclusions: Our findings provide important new insights regarding risk factors in adolescence associated with gambling behaviours and socioemotional harms

Socioeconomic status, mental wellbeing and transition to secondary school: analysis of the School Health Research Network/Health Behaviour in School-aged Children survey in Wales

Young people’s wellbeing is often lowest where they assume a relatively low position within their school’s socioeconomic hierarchy, for example, among poorer children attending more affluent schools. Transition to secondary school is a period during which young people typically enter an environment which is more socio-economically diverse than their primary school. Young people joining a school with a higher socioeconomic status intake relative to their primary school may assume a relatively lowered position within their schools’ socioeconomic hierarchy, experiencing a detriment to their wellbeing as a consequence. This paper draws on data from 45,055 pupils in Years 7 and 8, from 193 secondary schools in Wales, who completed the 2017 Student Health Research Network (SHRN) Student Health and Wellbeing (SHW) Survey. Pupils reported which primary school they previously attended, and survey data on wellbeing were linked to publicly available data on the Free School Meal entitlement of schools attended. In cross-classified linear mixed-effects models, with primary and secondary school as levels, mental wellbeing varied significantly according to both primary and secondary school attended. A higher school-level deprivation was associated with worse mental wellbeing in both cases. Mental wellbeing was significantly predicted by the relative affluence of a child’s primary and secondary school, with movement to a secondary school of higher overall socioeconomic status associated with lowered wellbeing. These findings highlight transition to secondary school as a key point in which socioeconomic inequality in wellbeing ma