Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK

Background: Evidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services. Methods: As part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis. Findings: 14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient −1·68, 95% CI −3·22 to −0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73–31·50; p=0·0069). Interpretation: Our findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services.This study was funded by The Wellcome Trust (grant number 074296), and the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care for Cambridgeshire and Peterborough

Universities futureproofing youth mental health: research confirms that offering mindfulness courses to students increases their wellbeing and resilience to stress

ABSTRACT Introduction Worldwide, increasing numbers of young people go to university, but there is concern about students’ rising need for mental health services. Young people’s journey through university provides a golden yet under-used opportunity for prevention. Mindfulness meditation training is popular amongst young people, but its effectiveness to increase wellbeing and resilience to stress in university students needs confirmation. Objective To address these issues the University of Cambridge has funded an implementation and evaluation project co-produced between the University Counselling Service, the Academic Division and the Department of Psychiatry. We designed a pragmatic, randomised controlled trial assessing the impact of providing mindfulness teaching before examinations to test the main hypothesis that it reduces students’ distress. Methods University of Cambridge students without severe mental illness or related crisis were randomly allocated to join an 8-week mindfulness course adapted for university students, or to just continue accessing to mental health support as usual (SAU). The main outcome was self-reported psychological distress during the examination period measured with the CORE Outcome Measure. Other results included the Warwick-Edinburgh Mental Wellbeing Scale, and adverse events. Main outcome analysis was masked to random allocation. An Advisory Reference Group involved students and other stakeholders. An independent committee provided oversight. Results A sample of 616 students took part (median age 22 years, 63% women); 309 were allocated to mindfulness, and 307 to SAU. Participants’ initial distress was higher than the general student population, but lower than students attending counselling; 74% completed the main outcome questionnaire. During the exam season mindfulness participants’ distress score was on average 0.25 CORE-OM points lower (95% confidence interval (CI) 0.16 to 0.34) than SAU participants’ distress. This difference bridges the gap between participants’ initial distress (0.99) and the general student population mean (0.76). Mindfulness participants were one third less likely to be in the clinical range of distress than SAU participants (risk ratio 0.65, 95%CI 0.53 to 0.80). SAU participants’ distress increased over the academic year whereas mindfulness group distress decreased after the course and was maintained during the exam period. Mindfulness also increased wellbeing. Effects were extremely unlikely to be due to chance (p<0.001). Mindfulness did not cause any significant adverse events. Conclusion Findings confirm that the provision of an 8-week mindfulness course effectively reduces distress and enhances wellbeing in university students. We hope that these results will impact significantly on student welfare policy, with mindfulness being implemented at universities more widely

Psychometric precision in phenotype definition is a useful step in molecular genetic investigation of psychiatric disorders.

Affective disorders are highly heritable, but few genetic risk variants have been consistently replicated in molecular genetic association studies. The common method of defining psychiatric phenotypes in molecular genetic research is either a summation of symptom scores or binary threshold score representing the risk of diagnosis. Psychometric latent variable methods can improve the precision of psychiatric phenotypes, especially when the data structure is not straightforward. Using data from the British 1946 birth cohort, we compared summary scores with psychometric modeling based on the General Health Questionnaire (GHQ-28) scale for affective symptoms in an association analysis of 27 candidate genes (249 single-nucleotide polymorphisms (SNPs)). The psychometric method utilized a bi-factor model that partitioned the phenotype variances into five orthogonal latent variable factors, in accordance with the multidimensional data structure of the GHQ-28 involving somatic, social, anxiety and depression domains. Results showed that, compared with the summation approach, the affective symptoms defined by the bi-factor psychometric model had a higher number of associated SNPs of larger effect sizes. These results suggest that psychometrically defined mental health phenotypes can reflect the dimensions of complex phenotypes better than summation scores, and therefore offer a useful approach in genetic association investigations.This work was supported by the Wellcome Trust [088869/Z/09/Z to M.R., P.B.J., D.G, and T. J. C,]; Medical Research Council [MC_UU_12019/1 and MC_UU_12019/3 to A.W, D.G., M.R]. Dr. Barnett is an employee of Cambridge Cognition, Ltd. This work forms part of the NIHR CLAHRC EoE that PBJ directs and the NIHR Cambridge Biomedical Research Centre.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by NPG

Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives

Background Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID—we investigate this area. Materials & methods We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. Results The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. Discussion In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.This paper presents independent research funded by the National Institute for Health Research (NIHR - www.nihr.ac.uk) under its Research for Patient Benefit (RfPB - https://www.nihr.ac.uk/funding-and-support/funding-for-research-studies/funding-programmes/research-for-patient-benefit/) Programme (Grant PB-PG-0706-10051; PI Dr H Ring). During the time that this research was carried out, AP Wagner, TJ Croudace, M Redley and H Ring also received support from the NIHR CLAHRC for Cambridgeshire and Peterborough (http://clahrc-cp.nihr.ac.uk/). In preparing this manuscript AP Wagner and H Ring received support from the NIHR Collaboration for Leadership in Applied Health Research and Care East of England at the Cambridgeshire and Peterborough NHS Foundation Trust (http://www.clahrc-eoe.nihr.ac.uk/). SR White was supported by the Medical Research Council (Unit Programme no. U105292687 - http://www.mrc.ac.uk/)

Ten-year outcomes in first episode psychotic major depression patients compared with schizophrenia and bipolar patients.

We aimed to investigate long-term outcomes in psychotic major depression patients compared to schizophrenia and bipolar/manic psychosis patients, in an incidence sample, while accounting for diagnostic change. Based on Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP and ÆSOP-10), a first episode psychosis cohort was followed-up 10years after first presentation. The Schedules for Clinical Assessment in Neuropsychiatry, WHO Life Chart and Global Assessment of Functioning were used to assess clinical, social and service use outcomes. Seventy-two PMD patients, 218 schizophrenia patients and 70 psychotic bipolar disorder/mania patients were identified at baseline. Differences in outcome between PMD and bipolar patients based on baseline and lifetime diagnosis were minimal. Differences in clinical, social and service use outcomes between PMD and schizophrenia were more substantial with PMD patients showing better outcomes on most variables. However, there was some weak evidence (albeit not quite statistically significant at p<0.05) based on lifetime diagnoses that PMD patients were more likely to attempt suicide (OR 2.31, CI 0.98-5.42, p0.055) and self-harm (OR 2.34, CI 0.97-5.68, p0.060). PMD patients have better social and service use outcomes compared to people with schizophrenia, but may be more likely to attempt suicide or self-harm. This unique profile is important for clinicians to consider in any risk assessment.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier

Lifetime affect and midlife cognitive function: prospective birth cohort study

Background: Recurrent affective problems are predictive of cognitive impairment, but the timing and directionality, and the nature of the cognitive impairment, are unclear. / Aims: To test prospective associations between life-course affective symptoms and cognitive function in late middle age. / Method: A total of 1668 men and women were drawn from the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Longitudinal affective symptoms spanning age 13-53 years served as predictors; outcomes consisted of self-reported memory problems at 60-64 years and decline in memory and information processing from age 53 to 60-64 years. / Results: Regression analyses revealed no clear pattern of association between longitudinal affective symptoms and decline in cognitive test scores, after adjusting for gender, childhood cognitive ability, education and midlife socioeconomic status. In contrast, affective symptoms were strongly, diffusely and independently associated with self-reported memory problems. / Conclusions: Affective symptoms are more clearly associated with self-reported memory problems in late midlife than with objectively measured cognitive performance

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

This research was financially supported by DG-Sanco (contract: 800197; 2007-2010). The authors would like to thank all of the professionals and services who participated in the PROMO assessment of services. A PhD grant from Fundação para a Ciência e Tecnologia–Portugal (SFRH/BD/66388/2009) to the first author is acknowledged

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Background We conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time). Objectives To determine variation in incidence of several psychotic disorders as above. Data Sources Published and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication. Study Eligibility Criteria Published 1950–2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence. Participants People, 16–64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis. Study Appraisal and Synthesis Methods Title, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I2-statistic. Results 83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6–40.9), 23.2 (95%CI: 18.3–29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9–19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0–17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I2: 0.54–0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4–9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3–6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3–4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported. Limitations Incidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results. Conclusions and Implications of Key Findings Incidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning