A qualitative inquiry of clinicians’ relational experiences within a perinatal infant mental health service contextualised with quantitative analysis of outcome measures

Literature highlights the perinatal period as a time of increased risk for mothers and infants, particularly those who have additional psychological and social risk factors. Enquiry reports underscore poor outcomes and service engagement for mothers from marginalized social contexts wherein relationships with services can be characterized by avoidance, distrust and silencing. Nuanced understandings of these relational processes are lacking and important to explore in the context of research supporting the therapist-parent relationship as a mechanism of therapeutic change. Within a Perinatal Infant Mental Health Service (PIMHS), this research aimed to explore clinicians’ relational experiences with the mothers and infants they work with, and their reflections on therapeutic change, and contextualize this with analysis of quantitative outcomes for mothers and infants engaged in PIMHS interventions. A qualitative inquiry using semi-structured interviews was undertaken with ten clinician participants and analysed using thematic analysis (TA). Quantitative analysis using Reliable and Clinically Significant Change calculations was conducted for six parent-infant dyads using pre and post-intervention scores on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and Mother Object Relationship Scale-Short Form (MORS-SF), alongside descriptive changes according to the Meaning of the Child Interview and safeguarding statuses. TA produced five main themes; ‘the overbearing wider context’, ‘professional positioning’, ‘dyadic/triadic relating’, ‘the self in the work’, and ‘connecting and expanding understanding’. Results highlight the multifaceted nature of experiences of clinicians working within the PIMHS through which wider contextual, inter-professional, dyadic/triadic, and intra-professional factors impact upon the work. Quantitative analyses of outcomes indicated a mixed profile of the extent that parents appeared to benefit from the PIMHS and demonstrated little consistency of change across measures. The discussion raises questions regarding how to measure the impact of the work, and the centrality of inter-disciplinary shared understanding in supporting families. Clinical and research implications are presented in the context of the findings and methodological limitations

Metacognitive impairments extend perceptual decision making weaknesses in compulsivity

AbstractAwareness of one’s own abilities is of paramount importance in adaptive decision making. Psychotherapeutic theories assume such metacognitive insight is impaired in compulsivity, though this is supported by scant empirical evidence. In this study, we investigate metacognitive abilities in compulsive participants using computational models, where these enable a segregation between metacognitive and perceptual decision making impairments. We examined twenty low-compulsive and twenty high-compulsive participants, recruited from a large population-based sample, and matched for other psychiatric and cognitive dimensions. Hierarchical computational modelling of the participants’ metacognitive abilities on a visual global motion detection paradigm revealed that high-compulsive participants had a reduced metacognitive ability. This impairment was accompanied by a perceptual decision making deficit whereby motion-related evidence was accumulated more slowly in high compulsive participants. Our study shows that the compulsivity spectrum is associated with a reduced ability to monitor one’s own performance, over and above any perceptual decision making difficulties.</jats:p

Brain-behaviour modes of covariation in healthy and clinically depressed young people

Abstract: Understanding how variations in dimensions of psychometrics, IQ and demographics relate to changes in brain connectivity during the critical developmental period of adolescence and early adulthood is a major challenge. This has particular relevance for mental health disorders where a failure to understand these links might hinder the development of better diagnostic approaches and therapeutics. Here, we investigated this question in 306 adolescents and young adults (14–24 y, 25 clinically depressed) using a multivariate statistical framework, based on canonical correlation analysis (CCA). By linking individual functional brain connectivity profiles to self-report questionnaires, IQ and demographic data we identified two distinct modes of covariation. The first mode mapped onto an externalization/internalization axis and showed a strong association with sex. The second mode mapped onto a well-being/distress axis independent of sex. Interestingly, both modes showed an association with age. Crucially, the changes in functional brain connectivity associated with changes in these phenotypes showed marked developmental effects. The findings point to a role for the default mode, frontoparietal and limbic networks in psychopathology and depression

The impact of the initial COVID-19 outbreak on young adults’ mental health: a longitudinal study of risk and resilience factors

Few studies assessing the effects of COVID-19 on mental health include prospective markers of risk and resilience necessary to understand and mitigate the combined impacts of the pandemic, lockdowns, and other societal responses. This population-based study of young adults includes individuals from the Neuroscience in Psychiatry Network (n = 2403) recruited from English primary care services and schools in 2012–2013 when aged 14–24. Participants were followed up three times thereafter, most recently during the initial outbreak of the COVID-19 outbreak when they were aged between 19 and 34. Repeated measures of psychological distress (K6) and mental wellbeing (SWEMWBS) were supplemented at the latest assessment by clinical measures of depression (PHQ-9) and anxiety (GAD-7). A total of 1000 participants, 42% of the original cohort, returned to take part in the COVID-19 follow-up; 737 completed all four assessments [mean age (SD), 25.6 (3.2) years; 65.4% female; 79.1% White]. Our findings show that the pandemic led to pronounced deviations from existing mental health-related trajectories compared to expected levels over approximately seven years. About three-in-ten young adults reported clinically significant depression (28.8%) or anxiety (27.6%) under current NHS guidelines; two-in-ten met clinical cut-offs for both. About 9% reported levels of psychological distress likely to be associated with serious functional impairments that substantially interfere with major life activities; an increase by 3% compared to pre-pandemic levels. Deviations from personal trajectories were not necessarily restricted to conventional risk factors; however, individuals with pre-existing health conditions suffered disproportionately during the initial outbreak of the COVID-19 pandemic. Resilience factors known to support mental health, particularly in response to adverse events, were at best mildly protective of individual psychological responses to the pandemic. Our findings underline the importance of monitoring the long-term effects of the ongoing pandemic on young adults’ mental health, an age group at particular risk for the emergence of psychopathologies. Our findings further suggest that maintaining access to mental health care services during future waves, or potential new pandemics, is particularly crucial for those with pre-existing health conditions. Even though resilience factors known to support mental health were only mildly protective during the initial outbreak of the COVID-19 pandemic, it remains to be seen whether these factors facilitate mental health in the long term

An expanding manifold in transmodal regions characterizes adolescent reconfiguration of structural connectome organization

Funder: Canada Research Chairs; FundRef: http://dx.doi.org/10.13039/501100001804Funder: Fonds de la Recherche du Quebec – SantéFunder: Autism Research TrustFunder: Canadian Institutes of Health Research; FundRef: http://dx.doi.org/10.13039/501100000024Funder: BrainCanadaFunder: MNI-Cambridge collaborative awardAdolescence is a critical time for the continued maturation of brain networks. Here, we assessed structural connectome development in a large longitudinal sample ranging from childhood to young adulthood. By projecting high-dimensional connectomes into compact manifold spaces, we identified a marked expansion of structural connectomes, with strongest effects in transmodal regions during adolescence. Findings reflected increased within-module connectivity together with increased segregation, indicating increasing differentiation of higher-order association networks from the rest of the brain. Projection of subcortico-cortical connectivity patterns into these manifolds showed parallel alterations in pathways centered on the caudate and thalamus. Connectome findings were contextualized via spatial transcriptome association analysis, highlighting genes enriched in cortex, thalamus, and striatum. Statistical learning of cortical and subcortical manifold features at baseline and their maturational change predicted measures of intelligence at follow-up. Our findings demonstrate that connectome manifold learning can bridge the conceptual and empirical gaps between macroscale network reconfigurations, microscale processes, and cognitive outcomes in adolescent development

Preference uncertainty accounts for developmental effects on susceptibility to peer influence in adolescence

Funder: The Wellcome Trust funded the ‘Neuroscience in Psychiatry Project’ (NSPN). All NSPN members (S-Table 4) are supported by a Wellcome Strategic Award (ref 095844/7/11/Z). Ray Dolan is supported by a Wellcome Investigator Award (ref 098362/Z/12/Z). The Max Planck – UCL Centre for Computational Psychiatry and Ageing is a joint initiative of the Max Planck Society and UCL. A.M.F. Reiter acknowledges support from the German Research Foundation (Deutsche Forschungsgesellschaft, DFG RE 4449/1-1, SFB 940-3, project B7) and by a 2020 NARSAD Young Investigator Grant from the Brain & Behavior Foundation. M. Moutoussis receives support from the NIHR UCLH Biomedical Research Centre. R.A. Kievit is supported by a Sir Henry Wellcome Trust Grant 107392/Z/15/Z and MRC Programme Grant SUAG/014 RG91365. E. Bullmore is in receipt of an NIHR Senior Investigator Award. P. Fonagy is in receipt of a National Institute for Health Research (NIHR) Senior Investigator Award (NF-SI-0514-10157). P. Fonagy was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. We are grateful to the NSPN management and research assistant teams.Abstract: Adolescents are prone to social influence from peers, with implications for development, both adaptive and maladaptive. Here, using a computer-based paradigm, we replicate a cross-sectional effect of more susceptibility to peer influence in a large dataset of adolescents 14 to 24 years old. Crucially, we extend this finding by adopting a longitudinal perspective, showing that a within-person susceptibility to social influence decreases over a 1.5 year follow-up time period. Exploiting this longitudinal design, we show that susceptibility to social influences at baseline predicts an improvement in peer relations over the follow-up period. Using a Bayesian computational model, we demonstrate that in younger adolescents a greater tendency to adopt others’ preferences arises out of a higher uncertainty about their own preferences in the paradigmatic case of delay discounting (a phenomenon called ‘preference uncertainty’). This preference uncertainty decreases over time and, in turn, leads to a reduced susceptibility of one’s own behaviour to an influence from others. Neuro-developmentally, we show that a measure of myelination within medial prefrontal cortex, estimated at baseline, predicts a developmental decrease in preference uncertainty at follow-up. Thus, using computational and neural evidence, we reveal adaptive mechanisms underpinning susceptibility to social influence during adolescence