Negative self-referential emotions and mental health in youth: The importance of self-criticism.

There are many measures available that survey positive and negative emotional indicators of wellbeing in children and adolescents (Žukauskienė et al, 2015). In fact, our work (Ashra et al., 2021) identifies 98 measures of negative self-referential emotions in youth populations. However, only eight of these measures incorporated an item examining negative self-referential emotions. This is important because negative self-referential emotions, especially self-criticism, are key antecedents of mental health disorders such as anxiety, depression and eating disorders (Löw, Schauenburg & Dinger, 2020). In this commentary, we discuss why measures relating to self-critical emotions are fundamental for children and adolescents, and much needed to comprehensively evaluate mental health and emotional wellbeing in youth. We believe our considerations here will enable scholars to: (i) develop robust self-criticism measures for children and adolescent populations, and (ii) reliably evaluate social and emotional interventions employed in schools and beyond, that are aimed at improving wellbeing through, in part, addressing self-critical thinking styles (e.g., compassion-based interventions)

A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes)

Aims   Type 2 diabetes mellitus (T2DM), a serious and prevalent chronic disease, is traditionally associated with older age. However, due to the rising rates of obesity and sedentary lifestyles, it is increasingly being diagnosed in the younger population. Sedentary (sitting) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes, including T2DM. Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM. We aimed to investigate, through a randomised controlled trial (RCT) design, whether a group-based structured education workshop focused on sitting reduction, with self-monitoring, reduced sitting time.  Methods   Adults aged 18–40 years who were either overweight (with an additional risk factor for T2DM) or obese were recruited for the Sedentary Time ANd Diabetes (STAND) RCT. The intervention programme comprised of a 3-hour group-based structured education workshop, use of a self-monitoring tool, and follow-up motivational phone call. Data were collected at three time points: baseline, 3 and 12 months after baseline. The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months. Secondary outcomes included other objective (activPAL) and self-reported measures of sedentary behaviour and physical activity, and biochemical, anthropometric, and psycho-social variables.  Results   187 individuals (69% female; mean age 33 years; mean BMI 35 kg/m2) were randomised to intervention and control groups. 12 month data, when analysed using intention-to-treat analysis (ITT) and per-protocol analyses, showed no significant difference in the primary outcome variable, nor in the majority of the secondary outcome measures.  Conclusions  A structured education intervention designed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months. Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change. Moreover, some participants reported a focus on physical activity rather than reductions in sitting per se. The habitual nature of sedentary behaviour means that behaviour change is challenging

Negative Self-referential Emotional Measures for use with Child and Youth samples and the Construction/Validation of ‘Self-criticism’ Emotional Measures for Child and Adolescent populations

The crisis in child and adolescent mental health and well-being has prompted the development of school and community-based interventions to tackle negative emotions towards the self (e.g., shame, guilt & self-criticism). To enable this, however, the use of robust, appropriate instruments to measure negative self-referential emotions is a necessity. Thus, an overarching aim of this PhD was to explore currently available self‑report measures of negative self‑referential emotions developed for non‑clinical child and adolescent samples and, if necessary, construct/validate appropriate ‘self-referential’ measures for children and adolescents where none exist. To this end, a systematic review of currently available child and adolescent self‑referential emotion measures revealed no appropriately validated measures of self-criticism for use in such populations. This is despite the importance of self-criticism during the identity-forming phase of childhood and adolescence, and its damaging effects on mental health. Therefore, the further overarching aims of this PhD were to develop and validate measures of self-criticism for use with child and adolescent populations. Using well-established scale development guidelines and validation procedures an interactive methodology, using both deductive and inductive methods, was utilised to develop the scale items. This included extensive literature searching, subject matter experts, and focus groups with the child and adolescent populations themselves. Exploratory factor analysis was then used to reduce the list of candidate items and to identify the underlying factor structure of the items. This resulted in two theoretically informed, qualitatively grounded and age sensitive measures, which capture the multifaceted nature of self-criticism according to child/adolescent development. These were a 15-item child scale - the Child Self-criticism scale (CSCs) for children aged seven-to-11 years characterised by two Factors (‘criticising self’ and ‘reassuring self’); and a 24-item adolescent scale - the Adolescent Self-criticism Scale (ACSs) for adolescents aged 11-to-16 years characterised by two Factors (‘critical self’ and ‘sensitivity to failure’). Both scales demonstrated high internal consistency, split-half reliability, test-retest reliability, and excellent concurrent validity through significant correlations between the scales, their subscales and validated measures of depression, perfectionism and self-compassion. Important implications of the scale developments included ‘negative evaluation by others' and ‘self-reassurance’ as key aspects of self-criticism in children, and 'inner critical voice', ‘self- critical rumination’, ‘physical appearance’ and ‘self-critical perfectionism’ as key aspects of self-criticism in adolescents. The impacts of this PhD body of research are three-fold. Firstly, a comprehensive systematic review has been conducted that will help researchers and practitioners make informed decisions about which tool or tools to use when investigating negative self-referential emotions. Secondly, researchers/practitioners and others can now use the CSCs and ASCs, with confidence, to evaluate the growing number of emotional well-being interventions utilised with child/adolescent populations to target negative self-referential emotions. Thirdly, the two developed measures can be used to identify children and adolescents with high(er) levels of self-criticism who may benefit from targeted interventions across educational and community settings, in a bid towards relieving the child mental health crisis currently unfolding

A retrospective evaluation of the NHS Health Check Programme in a multi ethnic population

Background The NHS Health Check Programme was introduced in 2009 to improve primary prevention of coronary heart disease, stroke, diabetes and chronic kidney disease; however, there has been debate regarding the impact. We present a retrospective evaluation of Leicester City Clinical Commissioning Group. Methods Data are reported on diagnosis of type 2 diabetes, hypertension, chronic kidney disease, high risk of type 2 diabetes and high risk of cardiovascular disease. Data on management following the Health Check is also reported. Results Over a five year period 53, 799 health checks were performed, 16, 388 (30%) people were diagnosed with at least one condition when diagnosis of being at high risk of cardiovascular disease was defined as ≥20% . This figure increased to 43% when diagnosis of high cardiovascular risk ≥10% was included. Of the 3,063 (5.7%) individuals diagnosed with type 2 diabetes 54 % were prescribed metformin and 26% were referred for structured education. Of the 5,797 (10.8%) individuals diagnosed at high risk of cardiovascular disease (≥20%) 64% were prescribed statins. Conclusion A high proportion of new cases of people at risk of cardiovascular disease were identified by the NHS Health Check Programme. Data suggest that this has translated into appropriate preventative measures

A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes)

AIMS: Type 2 diabetes mellitus (T2DM), a serious and prevalent chronic disease, is traditionally associated with older age. However, due to the rising rates of obesity and sedentary lifestyles, it is increasingly being diagnosed in the younger population. Sedentary (sitting) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes, including T2DM. Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM. We aimed to investigate, through a randomised controlled trial (RCT) design, whether a group-based structured education workshop focused on sitting reduction, with self-monitoring, reduced sitting time. METHODS: Adults aged 18-40 years who were either overweight (with an additional risk factor for T2DM) or obese were recruited for the Sedentary Time ANd Diabetes (STAND) RCT. The intervention programme comprised of a 3-hour group-based structured education workshop, use of a self-monitoring tool, and follow-up motivational phone call. Data were collected at three time points: baseline, 3 and 12 months after baseline. The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months. Secondary outcomes included other objective (activPAL) and self-reported measures of sedentary behaviour and physical activity, and biochemical, anthropometric, and psycho-social variables. RESULTS: 187 individuals (69% female; mean age 33 years; mean BMI 35 kg/m2) were randomised to intervention and control groups. 12 month data, when analysed using intention-to-treat analysis (ITT) and per-protocol analyses, showed no significant difference in the primary outcome variable, nor in the majority of the secondary outcome measures. CONCLUSIONS: A structured education intervention designed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months. Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change. Moreover, some participants reported a focus on physical activity rather than reductions in sitting per se. The habitual nature of sedentary behaviour means that behaviour change is challenging. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN08434554

Descriptive characteristics at baseline by randomisation group.

<p>Descriptive characteristics at baseline by randomisation group.</p

CONSORT diagram of participant flow through the trial.

<p>CONSORT diagram of participant flow through the trial.</p