Psychometric validation of a multi-dimensional capability instrument for outcome measurement in mental health research (OxCAP-MH)

Background Patient reported outcome measures (PROMs) are widely used in mental healthcare research for quality of life assessment but most fail to capture the breadth of health and non-health domains that can be impacted. We report the psychometric validation of a novel, multi-dimensional instrument based on Amartya Sen’s capability approach intended for use as an outcome measure in mental health research. Methods The Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) is a 16-item self-complete capability measure that covers multiple domains of functioning and welfare. Data for validation of the instrument were collected through a national randomised controlled trial of community treatment orders for patients with psychosis. Complete OxCAP-MH data were available for 172 participants. Internal consistency was established with Cronbach’s alpha; an interclass correlation coefficient was used to assess test-retest reliability in a sub-sample (N = 50) tested one week apart. Construct validity was established by comparing OxCAP-MH total scores with established instruments of illness severity and functioning: EuroQol (EQ-5D), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) and Objective Social Outcomes Index (SIX). Sensitivity was established by calculating standard error of measurement using distributional methods. Results The OxCAP-MH showed good internal consistency (Cronbach’s alpha 0.79) and test-retest reliability (ICC = 0.86). Convergent validity was evidenced by strong correlations with the EQ-5D (VAS 0.52, p < .001) (Utility 0.45, p < .001), and divergent validity through more modest associations with the BPRS (−0.41, p < .001), GAF (0.24, p < .001) and SIX (0.12, p = ns). A change of 9.2 points on a 0–100 scale was found to be meaningful on statistical grounds. Conclusions The OxCAP-MH has demonstrable reliability and construct validity and represents a promising multi-dimensional alternative to existing patient-reported outcome measures for quality of life used in mental health research

Work-related and personal predictors of Covid-19 transmission

The paper provides new evidence from a survey of 2000 individuals in the US and UK related to predictors of Covid-19 transmission. Specifically, it investigates work and personal predictors of transmission experience reported by respondents using regression models to better understand possible transmission pathways and mechanisms in the community. Three themes emerge from the analysis. Firstly, transport roles and travelling practices are significant predictors of infection. Secondly, evidence from the US especially shows union membership, consultation over safety measures and the need to use public transport to get to work are also significant predictors. This is interpreted as evidence of the role of deprivation and of reactive workplace consultations. Thirdly and finally, there is some, often weaker, evidence that income, car-owership, use of a shared kitchen, university degree type, risk aversion, extraversion and height are predictors of transmission. The comparative nature of the evidence indicates that the less uniformly stringent nature of the US lockdown provides more information about both structural and individual factors that predict transmission. The evidence about height is discussed in the context of the aerosol transmission debate. The paper concludes that both structural and individual factors must be taken into account when predicting transmission or designing effective public health measures and messages to prevent or contain transmission

Association of behavior in boys from low socioeconomic neighborhoods with employment earnings in adulthood

Importance Identifying early childhood behavioral problems associated with economic success/failure is essential for the development of targeted interventions that enhance economic prosperity through improved educational attainment and social integration. Objective To test the association between kindergarten teacher–rated assessments of inattention, hyperactivity, opposition, aggression, and prosociality in boys with their employment earnings at age 35 to 36 years as measured by government tax return data. Design, Setting, and Participants A 30-year prospective follow-up study analyzing low socioeconomic neighborhoods in Montreal, Quebec, Canada. Boys aged 5 to 6 years attending kindergarten in low socioeconomic neighborhoods were recruited. Teacher-rated behavioral assessments were obtained for 1040 boys. Data were collected from April 1984 to December 2015. Analysis began January 2017. Main Outcomes and Measures Mixed-effects linear regression models were used to examine the association between teacher ratings of inattention, hyperactivity, opposition, aggression, and prosociality at age 6 years and individual earnings obtained from government tax returns at age 35 to 36 years. The IQ of the child and family adversity were adjusted for in the analysis. Results Complete data were available for 920 study participants (mean age at follow-up was 36.3 years). Mean (SD) personal earnings at follow-up were $28 865.53 ($24 103.45) (range, $0-$142 267.84). A 1-unit increase in inattention (mean [SD], 2.66 [2.34]; range, 0-8) at age 6 years was associated with decrease in earnings at age 35 to 36 years of $1295.13 (95$2051.65 to −$538.62), while a unit increase in prosociality (mean [SD], 8.0 [4.96]; range, 0-20) was associated with an increase in earnings of$406.15 (95% CI, $172.54-$639.77). Hyperactivity, opposition, and aggression were not significantly associated with earnings. Child IQ was associated with higher earnings and family adversity with lower earnings in all models. A 1-SD reduction in inattention at age 6 years was associated with a theoretical increase in annual earnings of $3040.41, a similar magnitude to an equivalent increase in IQ. Conclusions and Relevance Teacher ratings of inattention and prosociality in kindergarten boys from low socioeconomic neighborhoods are associated with earnings in adulthood after adjustment for hyperactivity, aggression, and opposition, which were not associated with earnings. Interventions beginning in kindergarten that target boys’ inattention and enhance prosociality could positively impact workforce integration and earnings

Psychiatric compulsion and long-term social outcomes for patients with psychosis: is there an association?

Compulsory interventions are widely used in general adult psychiatry for the treatment and care of patients with severe mental illness. While involuntary hospitalisation is established in practice around the world, the use of compulsory interventions outside of hospital – so called community treatment orders (CTOs) – is a more recent development. Three randomised controlled trials of CTO effectiveness have been conducted to date finding no benefits for patients in terms of reduced relapse and readmission to hospital. However, these trials have been relatively short (11-12 months) and focused almost exclusively on CTO effects on clinical functioning and service use. Little attention has been given to patients' social outcomes and broader welfare despite their recognised importance. A sub-sample (n = 121) from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48-months after randomisation to assess whether the duration of the CTO intervention was associated with more or less favourable social outcomes at follow-up. Social outcomes were assessed using three main concepts: social networks (Study 1), social inclusion (Study 2), and capabilities (Study 3). No significant associations between the duration of the CTO intervention and social outcomes at follow-up were found. The association between involuntary hospitalisation and social outcomes was also tested but no significant associations were found. Because the field of social outcome measurement is relatively undeveloped, a further aim was to contribute to the validation and testing of two recently developed instruments: the Social and Community Opportunities Profile (SCOPE) (Study 4) and the Oxford Capability Questionnaire for Mental Health (OxCAP-MH) (Study 5). The SCOPE performed well overall as a measure of social inclusion but questions were raised about its feasibility (length) and the reliability of one of its sub-scales. The OxCAP-MH demonstrated good psychometric properties (reliability and validity) and represents a promising new multi-dimensional patient-reported outcome measure for use in mental health research. </p

Psychiatric compulsion and long-term social outcomes for patients with psychosis: is there an association?

Compulsory interventions are widely used in general adult psychiatry for the treatment and care of patients with severe mental illness. While involuntary hospitalisation is established in practice around the world, the use of compulsory interventions outside of hospital â so called community treatment orders (CTOs) â is a more recent development. Three randomised controlled trials of CTO effectiveness have been conducted to date finding no benefits for patients in terms of reduced relapse and readmission to hospital. However, these trials have been relatively short (11-12 months) and focused almost exclusively on CTO effects on clinical functioning and service use. Little attention has been given to patients' social outcomes and broader welfare despite their recognised importance. A sub-sample (n = 121) from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48-months after randomisation to assess whether the duration of the CTO intervention was associated with more or less favourable social outcomes at follow-up. Social outcomes were assessed using three main concepts: social networks (Study 1), social inclusion (Study 2), and capabilities (Study 3). No significant associations between the duration of the CTO intervention and social outcomes at follow-up were found. The association between involuntary hospitalisation and social outcomes was also tested but no significant associations were found. Because the field of social outcome measurement is relatively undeveloped, a further aim was to contribute to the validation and testing of two recently developed instruments: the Social and Community Opportunities Profile (SCOPE) (Study 4) and the Oxford Capability Questionnaire for Mental Health (OxCAP-MH) (Study 5). The SCOPE performed well overall as a measure of social inclusion but questions were raised about its feasibility (length) and the reliability of one of its sub-scales. The OxCAP-MH demonstrated good psychometric properties (reliability and validity) and represents a promising new multi-dimensional patient-reported outcome measure for use in mental health research. </p

Work-Related and Personal Predictors of COVID-19 Transmission: Evidence from the UK and US

Objective To develop evidence of work-related and personal predictors of COVID-19 transmission. Setting and Respondents Data are drawn from a population survey of individuals in the US and UK conducted in June 2020. Background Methods Regression models are estimated for 1467 individuals in which reported evidence of infection depends on work- related factors as well as a variety of personal controls. Results The following themes emerge from the analysis. Firstly, a range of work related factors are significant sources of variation in COVID-19 infection as indicated by self-reports of medical diagnosis or symptoms. This includes evidence about workplace types, consultation about safety and union membership. The partial effect of transport related employment in regression models makes the chance of infection over three times more likely while in univariate analyses, transport related work increases the risk of infection by over 40 times in the US. Secondly, there is evidence that some home related factors are significant predictors of infection, most notably the sharing of accommodation or a kitchen. Thirdly, there is some evidence that behavioural factors and personal traits (including risk preference, extraversion and height) are important also. Conclusions The paper concludes that predictors of transmission relate to work, transport, home and personal factors. Transport related work settings are by far the greatest source of risk and so should be a focus of prevention policies. In addition, surveys of the sort developed in this paper are an important source of information on transmission pathways within the community

Behaviors in kindergarten are associated with trajectories of long-term welfare receipt: A 30-year population-based study

This study examines the link between behavior in kindergarten and adult-life welfare receipt. Teacher-rated behavioral assessments were obtained for inattention, hyperactivity, aggression-opposition, anxiety, and prosociality when children (n=2960) were aged 5-6 years and linked to their tax return records from age 18-35 years. We used group-based based trajectory modeling to identify distinct trajectories of welfare receipt and multinomial logistic regression models to examine the association between behaviors and trajectory group membership. The child's sex, IQ, and family background were adjusted for. Four trajectories of welfare receipt were identified: low (n = 2,390, 80.7%), declining (n = 260, 8.8%), rising (n = 150, 5.2%), and chronic (n = 160, 5.4%). Relative to the low trajectory, inattention and aggression-opposition at age 6 years were associated with increased risk of following a declining, rising, and chronic trajectory of welfare receipt, independent of hyperactivity and anxiety. Prosocial behaviors were independently associated with a lower risk of following a chronic trajectory. This study shows that kindergarten children exhibiting high inattention and aggression-opposition and low prosocial behaviors may be at increased risk of long-term welfare receipt in adulthood. The implications for early screening, monitoring, and prevention are discussed

Int J Ment Health Addict

Background: Research is yet to elucidate adolescent polysubstance use profiles among youth with early-onset cannabis use (CU; ≤15 years). The present study aimed to fill this gap in the literature and determine whether CU outcomes in early adulthood are best explained by early-onset CU per se, or by its resulting polysubstance use profiles. Methods: Participants were N = 794 youth (56% females) from the Québec Longitudinal Study of Child Development, who reported lifetime CU by age 21. Participants were stratified into early-onset (n = 349), later adolescent-onset (16–18 years; n = 359), and adult-onset (≥19 years; n = 86) CU groups. Self-reported substance use was collected from the early-onset CU group at age 15 and 17, while CU frequency and problem CU were assessed for all participants at age 21. Results: Repeated measures latent profile analyses revealed four polysubstance use profiles among youth in the early-onset CU group: (1) light (54%); (2) escalating (13%); (3) frequent (without cigarettes; 14%); (4) frequent (with cigarettes; 19%). Only youth in the early-onset CU group who followed an escalating or frequent (with cigarettes) adolescent polysubstance use profile had consistently greater CU frequency and problem CU at 21 years, compared to youth in the later adolescent-onset (16–18 years), or adult-onset (≥19 years) CU groups (β range = 0.13 to.40; Cohen’s f2 range = 0.02 to 0.12). Conclusions: Youth with early-onset CU are not a single homogenous group, but rather follow unique polysubstance use profiles that are differentially associated with risk for future problem CU

Developmental profiles of childhood attention-deficit/hyperactivity disorder and irritability: association with adolescent mental health, functional impairment, and suicidal outcomes

Background: Irritability is frequently comorbid with ADHD. Although irritability alone has been linked to deleterious mental health and adaptive issues, the joint developmental course of ADHD and irritability symptoms during childhood as well as its association with later mental health and suicidal outcomes is not fully understood. We aimed to describe the developmental trajectories of childhood ADHD and irritability symptoms and to quantify their association with adolescent mental health and suicidal outcomes.Methods: The Quebec Longitudinal Study of Child Development (QLSCD) included 1407 participants from the general population followed up from age 5 months to 17 years. We used a multitrajectory approach to identify developmental trajectories of childhood (6-12 years) ADHD and irritability symptoms. Outcome measures were adolescent (13-17 years) mental health (psychiatric symptoms/functional impairment) and suicidal outcomes.Results: We identified distinct developmental profiles: combined absent or very low ADHD and absent or very low irritability (940 [66.8%]; reference group), moderately high irritability and low ADHD (158 [11.2%]), moderately high ADHD and low irritability (198 [14.1%]), and combined high ADHD and high irritability (111 [7.9%]). Multivariate modeling showed that, compared to children in the reference group, those in the combined high ADHD and high irritability profile showed higher levels of ADHD continuity (d ranges = 0.40-0.50), externalizing (d ranges = 0.25-0.59), internalizing (d ranges = 0.20-0.29), and functional impairments (d ranges = 0.17-0.48) and suicidal behaviors (odds ratio (OR) = 2.12, confidence interval (CI) = 1.47-3.06) in adolescence.Conclusions: The presence of persistently high levels of irritability along with ADHD symptoms during childhood significantly predicts adolescent ADHD continuity, externalizing, internalizing, and suicidal outcomes. Systematic consideration of irritability when assessing and treating ADHD may improve long-term mental health outcomes