Racialised staff–patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data

Background The current study is a secondary analysis of qualitative data collected as part of EURIPIDES, a study which assessed how patient experience data were used to improve the quality of care in National Health Service (NHS) mental health services. Objective We undertook a detailed realist secondary qualitative analysis of 10 interviews in which expressions of racialisation were unexpectedly reported. This theme and these data did not form part of the primary realist evaluation. Methods Interviews were originally conducted with the patients (18–65 years: 40% female, 60% male) from four different geographically located NHS England mental health trusts between July and October 2017. Secondary qualitative data analysis was conducted in two phases: (1) reflexive thematic analysis and retroduction; (2) refinement of context–mechanism–outcome configurations to explore the generative mechanisms underpinning processes of racialisation and revision of the initial programme theory. Findings There were two main themes: (1) absence of safe spaces to discuss racialisation which silenced and isolated patients; (2) strained communication and power imbalances shaped a process of mutual racialisation by patients and staff. Non-reporting of racialisation and discrimination elicited emotions such as feeling othered, misunderstood, disempowered and fearful. Conclusions The culture of silence, non-reporting and power imbalances in inpatient wards perpetuated relational racialisation and prevented authentic feedback and staff–patient rapport. Clinical implications Racialisation in mental health trusts reflects lack of psychological safety which weakens staff–patient rapport and has implications for authentic patient engagement in feedback and quality improvement processes. Larger-scale studies are needed to investigate racialisation in the staff–patient relationships

A shared genetic propensity underlies experiences of bullying victimization in late childhood and self-rated paranoid thinking in adolescence

Background: Bullying is a risk factor for developing psychotic experiences (PEs). Whether bullying is associated with particular PEs, and the extent to which genes and environments influence the association, are unknown. This study investigated which specific PEs in adolescence are associated with earlier bullying victimization and the genetic and environmental contributions underlying their association. Method: Participants were 4826 twin pairs from a longitudinal community-based twin study in England and Wales who reported on their bullying victimization at the age of 12 years. Measures of specific PEs (self-rated Paranoia, Hallucinations, Cognitive disorganization, Grandiosity, Anhedonia, and parent-rated Negative Symptoms) were recorded at age of 16 years. Results: Childhood bullying victimization was most strongly associated with Paranoia in adolescence (r = .26; P < .01), with weaker associations with Hallucinations, Cognitive Disorganization, parent-rated Negative Symptoms (r = .12–.20; P < .01), Grandiosity (r = .04; P < .05), and Anhedonia (r = .00, n.s.). Bivariate twin model-fitting demonstrated that bullying victimization and Paranoia were both heritable (35% and 52%, respectively) with unique environmental influences (39% and 48%, respectively), and bullying victimization showed common environmental influences (26%). The association between bullying victimization and Paranoia operated almost entirely via genetic influences (bivariate heritability = 93%), with considerable genetic overlap (genetic correlation = .55). Conclusion: In contrast to the assumed role of bullying victimization as an environmental trigger, these data suggest that bullying victimization in late childhood is particularly linked to self-rated Paranoia in adolescence via a shared genetic propensity. Clinically, individuals with a history of bullying victimization are predicted to be particularly susceptible to paranoid symptoms

Association between stressful life events and psychotic experiences in adolescence: evidence for gene-environment correlations

- Background: Stressful life events (SLEs) are associated with psychotic experiences (PEs). SLEs might act as an environmental risk factor, but may also share a genetic propensity with PEs. - Aims: Estimate the extent to which genetic and environmental factors influence the relationship between SLEs and PEs. - Method: Self and parent-reports from a community-based twin sample (4,830 16-year-old pairs) were analysed using structural equation model-fitting. - Results: SLEs correlated with positive PEs (r = .12-.14, all p<. 001). Modest heritability was shown for PEs (25-57%) and dependent SLEs (32%). Genetic influences explained the majority of the modest covariation between dependent SLEs and paranoia and cognitive disorganisation (bivariate heritabilities = 74-86%). The relationship between SLEs and hallucinations and grandiosity was explained by both genetic and common environmental effects. - Conclusion: Further to dependent SLEs being an environmental risk factor, individuals may have an underlying genetic propensity increasing their risk of dependent SLEs and positive PEs

Psychotic experiences are linked to cannabis use in adolescents in the community because of common underlying environmental risk factors

Cannabis users are more likely to have psychotic experiences (PEs). The degree to which these associations are driven by genetic or environmental influences in adolescence is unknown. This study estimated the genetic and environmental contributions to the relationship between cannabis use and PEs. Specific PEs were measured in a community-based twin sample (4830 16-year-old pairs) using self-reports and parent-reports. Adolescents reported on ever using cannabis. Multivariate liability threshold structural equation model-fitting was conducted. Cannabis use was significantly correlated with PEs. Modest heritability (37%), common environmental influences (55%) and unique environment (8%) were found for cannabis use. For PEs, modest heritability (27-54%), unique environmental influences (. E=12-50%) and little common environmental influences (11-20%), with the exception of parent-rated Negative Symptoms (42%), were reported. Environmental influences explained all of the covariation between cannabis use and paranoia, cognitive disorganization and parent-rated negative symptoms (bivariate common environment=69-100%, bivariate unique environment=28-31%), whilst the relationship between cannabis use and hallucinations indicated familial influences. Cannabis use explains 2-5% of variance in positive, cognitive, and negative PEs. Cannabis use and psychotic experience co-occur due to environmental factors. Focus on specific environments may reveal why adolescent cannabis use and psychotic experiences tend to 'travel together'

A cross‐sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community

Background: Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association. Methods: Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13–14‐year‐olds in Cornwall, United Kingdom in 2017‐2019. In a cross‐sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated. Results: Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [−0.02,0.44]). Conclusions: Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13–14‐year‐olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry

Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom

Background Youth adversity is associated with persistence of depression and anxiety symptoms. This association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g. males). Given that persistent symptoms are observed across a range of disadvantaged, minoritized, and neurodivergent groups (e.g. low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. Methods Data from HeadStart Cornwall (N = 4441) was used to assess the effect of youth adversity on combined symptoms of depression and anxiety (Strengths and Difficulties Questionnaire emotional problems subscale) measured at three time-points in 11–14-year-olds. Latent trajectories and regressions were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention), and moderating effects of the individual characteristics and their intersections were estimated. Results Youth adversity was associated with higher average depression/anxiety symptoms at baseline (11–12-years) across all intersectionality profiles. The magnitude of effects differed across profiles, with suggestive evidence for a moderating effect of youth adversity on change over time in depression/anxiety symptoms attributable to the intersection between (i) gender and SES; and (ii) gender, SES, and hyperactivity/inattention. Conclusions The detrimental effects of youth adversity pervade across intersectionality profiles. The extent to which these effects are moderated by intersectionality is discussed in terms of operational factors. The current results provide a platform for further research, which is needed to determine the importance of intersectionality as a moderator of youth adversity on the development of depression and anxiety symptoms in adolescence

The impact of intersectionality profiles on the relation between early adverse experiences and emotional problems in adolescence

Early adverse experiences such as abuse and bullying victimisation are robust predictors of poor mental health later in life (Bellis et al., 2019). There is initial evidence which indicates that the strength of this relation varies by individual characteristics, such as gender and ethnicity (e.g., Jones et al., 2022; Forster et al., 2018; Lee &amp; Chen, 2017; Schilling et al., 2007). There are also findings to suggest that the intersection between these characteristics (e.g., female and ethnic minority) is associated with later mental health (Kern et al., 2020), and early adverse experiences (Ickert et al., 2022; Mersky et al., 2021). However, there are no published findings to our knowledge that consider the impact of the intersection between individual characteristics (e.g., female and ethnic minority) on the relation between early adverse experiences and mental health. According to intersectionality theory, individual characteristics (e.g., gender and ethnicity) that reflect proxies for social oppression and privilege, interact to give rise to unique social experience. Gaining an understanding of the extent to which and the ways in which intersectionality profiles are associated with risk of and resilience to psychopathology in the face of early adversity, requires the inclusion of diverse representative samples. Here, we present a preregistration for the OxWell project as part of the ATTUNE project Work Package 2, which aims to investigate early adversity and mental health in young people in the community in the context of intersectionality, using existing datasets

Intergenerational Continuity of Intimate Partner Violence Perpetration: An Investigation of Possible Mechanisms.

Intimate partner violence (IPV) is a continuum of abuse that is associated with a number of negative outcomes including substance misuse, depression, and suicidal ideation. This study aims to investigate the intergenerational transmission of IPV perpetration and the mechanisms involved. Intergenerational transmission was investigated using information from two generations of the Cambridge Study in Delinquent Development which is a prospective longitudinal study of 411 males from an inner London area in the UK who have been followed up over a period of 50 years. Information with regard to IPV perpetration, specifically physical violence, was garnered from self-reports by the male at age 32, from their female partner at age 48, and from their male and female children in early adulthood. Regression analyses were used to investigate intergenerational transmission and examine whether psychosocial risk factors could be identified as potential intergenerational pathways. Having a father who was a perpetrator of IPV significantly increased the odds of daughters being perpetrators by 2 times. It did not significantly increase the odds for sons. The intergenerational transmission of IPV perpetration remains between fathers and their daughters over and above a series of psychosocial factors such as accommodation problems and alcohol misuse. Identification of factors associated with the intergenerational transmission of IPV perpetration will inform practitioners and policymakers. Information garnered from studies such as this may contribute to the development of prevention and intervention strategies for those at risk