Mental health literacy of negative body image: symptom recognition and beliefs about body image in a British community sample

The present study examined mental health literacy of negative body image in a sample of 485 British adults. Participants were presented with vignettes of a fictional woman (‘Kate’) and man (‘Jack’) suffering from negative body image and were asked questions addressing symptom recognition, distress, sympathy and sources of help-seeking. Participants also completed measures of body appreciation and psychiatric skepticism. Results showed that less than a fifth of participants correctly identified the vignettes as depicting cases of negative body image. The vignette describing Kate was rated as significantly more distressing, deserving of sympathy and requiring help than that of Jack. Women rated the conditions described by both vignettes as significantly more distressing and requiring help than did men. Psychiatric skepticism and body appreciation were significantly associated with beliefs about the vignettes. Implications of the results for the promotion of mental health literacy in relation to body image are discussed

Trajectories of depressive symptoms among young people in London, UK, and Tokyo, Japan: a longitudinal cross-cohort study

BACKGROUND: Research suggests gender inequalities in adolescent mental health are context dependent and might be preventable through social and structural change. However, variations in the size of gender inequalities in mental health across diverse cultural contexts could be due to incomparable measurement. We aimed to compare a measurement of mental health among young people in Tokyo, Japan, and London, UK, and test the hypothesis that gender inequalities in depressive symptom trajectories are larger in London than in Tokyo. METHODS: For this longitudinal cross-cohort study, we extracted responses to the 13-item Short Mood and Feelings Questionnaire (SMFQ) by young people who participated in three consecutive waves of the Tokyo Teen Cohort (TTC) and the London-based Resilience, Ethnicity and Adolescent Mental Health (REACH) cohorts. We used multigroup and longitudinal confirmatory factor analysis to examine measurement invariance of the SMFQ by cohort, gender, and age. Latent growth curve models were used to estimate and compare mean trajectories of SMFQ from ages 11-16 years among boys and girls, overall, and in each cohort. FINDINGS: 7100 young people from TTC and REACH (3587 boys [50·5%] and 3513 girls [49·5%]) were included in the analysis. With the TTC and REACH cohorts combined, we found very strong evidence of differences in SMFQ between boys and girls, with a mean starting level of 0·71 points (95% CI 0·42-0·95) higher and mean rate of change of 0·73 points (95% CI 0·62-0·82) higher in girls versus boys. Among the 4287 participants in REACH (2097 [48·9%] boys and 2190 [51·1%] girls), a difference in SMFQ was evident between boys and girls at age 11-12 years (difference in mean intercepts: 0·75 [95% CI 0·25-1·25]). Among the 2813 participants in TCC (1490 boys [53·0%] and 1323 girls [47·0%]), differences in SMFQ between boys and girls emerged at a later age, between ages 11 years and 14 years, during which SMFQ decreased among boys and increased among girls (mean difference in slopes 0·52 [95% CI 0·40 to 0·65]). The difference in SMFQ between boys and girls widened year-on-year in both cohorts; by age 16 years, the difference in SMFQ between boys and girls in REACH (mean difference in slopes 0·98 [95% CI 0·77 to 1·20]) was around twice as large as in TTC (0·52 [0·40 to 0·65]). The annual rate of increase in SMFQ among girls in REACH (1·1 [95% CI 0·9-1·3]) was around four times greater than among girls in TTC (0·3 [0·2-0·4]). We found little evidence to suggest these differences in gender inequalities were due to incomparable measurement. INTERPRETATION: Gender inequalities in emotional health among young people are context dependent and might be preventable through social and structural change. FUNDING: Japanese Society for the Promotion of Science, UK Economic and Social Research Council, and European Research Council. TRANSLATION: For the Japanese translation of the abstract see Supplementary Materials section

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme