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People with intellectual disability often face barriers accessing mainstream psychological services due to a lack of reasonable adjustments, including the absence of adapted versions of routine outcome measures. Adapted versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) have been created for adults with ID.
Aims:
This study aims to evaluate the psychometric properties of the adapted PHQ-9 and GAD-7.
Method:
The adapted PHQ-9 and GAD-7 and the Glasgow Depression and Anxiety Scales (GDS-ID, GAS-ID) were administered to 47 adults (n=21 clinical group; n=26 community group) with ID. Cross-sectional design and between-group analyses tested for discriminant validity. Concurrent and divergent validity was tested using correlational designs. Reliability was investigated by internal consistency and test–retest analysis.
Results:
The clinical group scored significantly higher on the adapted PHQ-9 (t45=–2.28, p=.03, 95% CI [–7.09, –.45]) and GAD-7 (t45=–3.52, p=.001, 95% CI [–7.44, –2.02]) than the community group, evidencing discriminant validity. The adapted PHQ-9 correlated with the GDS-ID (r47=.86, p<.001) and the adapted GAD-7 correlated with the GAS-ID (r46=.77, p<.001). The adapted PHQ-9 (Cronbach’s α=.84, ICC=.91) and GAD-7 (Cronbach’s α=.86, ICC=.77) had good internal consistency and test–retest reliability.
Conclusions:
Preliminary research suggests the adapted PHQ-9 and GAD-7 are valid and reliable measures. They could provide a reasonable adjustment for the minimum dataset used in NHS Talking Therapies and can be easily administered in routine clinical practice. Further work to establish additional psychometric properties is now required.
Given the US population concentration near coastal areas and increased flooding due to climate change, public health professionals must recognize the psychological burden resulting from exposure to natural hazards.
Methods
We performed a systematic search of databases to identify articles with a clearly defined comparison group consisting of either pre-exposure measurements in a disaster-exposed population or disaster-unexposed controls, and assessment of mental health, including but not limited to, depression, post-traumatic stress (PTS), and anxiety.
Results
Twenty-five studies, with a combined total of n =616 657 people were included in a systematic review, and 11 studies with a total of 2012 people were included in a meta-analysis of 3 mental health outcomes. Meta-analytic findings included a positive association between disaster exposure and PTS (n = 5, g = 0.44, 95% CI 0.04, 0.85), as well as depression (n = 9, g = 0.28, 95% CI 0.04, 0.53), and no meaningful effect size in studies assessing anxiety (n = 6, g = 0.05 95% CI −0.30, 0.19).
Conclusions
Hurricanes and flooding were consistently associated with increased depression and PTS in studies with comparison groups representing individuals unaffected by hazards.
We investigated associations between ‘healthy dietary pattern’ scores, at ages 36, 43, 53 and 60–64 years, and body composition at age 60–64 years among participants from the MRC National Survey of Health and Development (NSHD). Principal component analyses of dietary data (food diaries) at age 60–64 years were used to calculate diet scores (healthy dietary pattern scores) at each age. Higher scores indicated healthier diets (higher consumption of fruit, vegetables and wholegrain bread). Linear regression was used to investigate associations between diet scores at each age and height-adjusted dual-energy X-ray absorptiometry-measured fat and lean mass measures at age 60–64 years. Analyses, adjusting for sex and other potential confounders (age, smoking history, physical activity and occupational class), were implemented among 692 men and women. At age 43, 53 and 60–64 years, higher diet scores were associated with lower fat mass index (FMI) and android:gynoid fat mass ratio; for example, in fully adjusted analyses, a standard deviation (sd) increase in diet score at age 60–64 years was associated with an SD difference in mean FMI of −0·18 (95 % CI: −0·25, −0·10). In conditional analyses, higher diet scores at ages 43, 53 and 60–64 years (than expected from diet scores at younger ages) were associated with lower FMI and android:gynoid fat mass ratio in fully adjusted analyses. Diet scores at age 36 years had weaker associations with the outcomes considered. No associations regarding appendicular lean mass index were robust after full adjustment. This suggests that improvements in diet through adulthood are linked to beneficial effects on adiposity in older age.
To consider how self-reported physical function measures relate to adverse clinical outcomes measured over 20 years of follow-up in a community-dwelling cohort (aged 59–73 at baseline) as compared with hand grip strength, a well-validated predictor of adverse events.
Background:
Recent evidence has emphasized the significant association of physical activity, physical performance, and muscle strength with hospital admissions in older people. However, physical performance tests require staff availability, training, specialized equipment, and space to perform them, often not feasible or realistic in the context of a busy clinical setting.
Methods:
In total, 2997 men and women were analyzed. Baseline predictors were measured grip strength (Jamar dynamometer) and the following self-reported measures: physical activity (Dallosso questionnaire); physical function score (SF-36 Health Survey); and walking speed. Participants were followed up from baseline (1998–2004) until December 2018 using UK Hospital Episode Statistics and mortality data, which report clinical outcomes using ICD-10 coding. Predictors in relation to the risk of mortality and hospital admission events were examined using Cox regression with and without adjustment for sociodemographic and lifestyle characteristics.
Findings:
The mean age at baseline was 65.7 and 66.6 years among men and women, respectively. Over follow-up, 36% of men and 26% of women died, while 93% of men and 92% of women were admitted to hospital at least once. Physical activity, grip strength, SF-36 physical function, and walking speed were all strongly associated with adverse health outcomes in both sex- and fully adjusted analyses; poorer values for each of the predictors were related to greater risk of mortality (all-cause, cardiovascular-related) and any, neurological, cardiovascular, respiratory, any fracture, and falls admissions. SF-36 physical function and grip strength were similarly associated with the adverse health outcomes considered.
Depression, anxiety and insomnia often co-occur. However, there is a lack of research regarding how they cluster and how this is related to medication used to treat them.
Aims
To describe the frequencies and associations between depression, anxiety and insomnia, and treatment for these conditions in primary care.
Method
A retrospective cohort study using UK electronic primary care records. We included individuals aged between 18 and 99 years old with one or more records suggesting they had a diagnosis, symptom or drug treatment for anxiety, depression or insomnia between 2015 and 2017. We report the conditional probabilities of having different combinations of diagnoses, symptoms and treatments recorded.
Results
There were 1 325 960 records indicative of depression, anxiety or insomnia, for 739 834 individuals. Depression was the most common condition (n = 106 117 records), and SSRIs were the most commonly prescribed medication (n = 347 751 records). Overall, individuals with a record of anxiety were most likely to have co-occurring symptoms and diagnoses of other mental health conditions. For example, of the individuals with a record of generalised anxiety disorder (GAD), 24% also had a diagnosis of depression. In contrast, only 0.6% of those who had a diagnosis of depression had a diagnosis or symptom of GAD. Prescribing of more than one psychotropic medication within the same year was common. For example, of those who were prescribed an SNRI (serotonin-norepinephrine reuptake inhibitor), 40% were also prescribed an SSRI (selective serotonin reuptake inhibitor).
Conclusions
The conditional probabilities of co-occurring anxiety, depression and insomnia symptoms, diagnoses and treatments are high.
Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries.
Design:
We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age.
Results:
We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures.
Conclusions:
Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.
Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited.
Aims
To develop a testable psychological framework explaining violence in psychosis – grounded in patient experience – to guide targeted treatment development.
Method
We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis.
Results
Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour.
Conclusions
The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.
Perhaps more than most ancient traditions, Thecla’s has been characterized by controversy, and yet little attention has been paid to the positive value of indeterminacy in the Thecla tradition. After offering an overview of approaches to the Acts of Paul and Thecla and related texts over the last half-century, we ask how the open qualities of Thecla as a protagonist may have enhanced her tradition’s ability to serve as the basis for successive re-imaginings. We conclude by suggesting that as ‘an ambiguous heroine in an unstable story’ Thecla exemplifies the value of indeterminacy and instability in hagiography.
Post-traumatic stress disorder (PTSD) is commonly experienced by asylum seekers and refugees (ASR). Evidence supports the use of cognitive behavioural therapy-based treatments, but not in group format for this population. However, group-based treatments are frequently used as a first-line intervention in the UK.
Aims:
This study investigated the feasibility of delivering a group-based, manualised stabilisation course specifically developed for ASR. The second aim was to evaluate the use of routine outcome measures (ROMs) to capture psychological change in this population.
Method:
Eighty-two participants from 22 countries attended the 8-session Moving On After Trauma (MOAT) group-based stabilisation treatment. PHQ-9, GAD-7, IES-R and idiosyncratic outcomes were administered pre- and post-intervention.
Results:
Seventy-one per cent of participants (n = 58) attended five or more of the treatment sessions. While completion rates of the ROMs were poor – measures were completed at pre- and post-intervention for 46% participants (n = 38) – a repeated-measures MANOVA indicated significant improvements in depression (p = .001, ηp2 = .262), anxiety (p = .000, ηp2 = .390), PTSD (p = .001, ηp2 = .393) and idiosyncratic measures (p = .000, ηp2 = .593) following the intervention.
Conclusions:
Preliminary evidence indicates that ASR who attended a low-intensity, group-based stabilisation group for PTSD experienced lower mental health scores post-group, although the lack of a comparison group means these results should be interpreted with caution. There are significant challenges in administering ROMs to individuals who speak many different languages, in a group setting. Nonetheless, groups have benefits including efficiency of treatment delivery which should also be considered.
This chapter asks what light the well-known but little understood story of Augustine’s relationship to the mother of his first child can shed on our understanding of marriage as an asymmetrical institution in the Roman period. Reviewing the evidence that both pagans and Christians in late antiquity expected a ‘double standard’ for men and women where marital fidelity was concerned, we suggest that Augustine’s On the Good of Marriage argued for a new marriage ethics based on sexual symmetry, capturing a new spirit of criticism for the double standard in fourth-century preaching, and that Augustine invoked his own experiences (as recounted in the Confessions) in order to drive home his argument.
The studies in Part III explore how the Christian preachers and writers of late antiquity used a wide range of pedagogical and literary techniques to evoke empathetic responses in their audiences. Deployed effectively, such techniques could prove pivotal in cultivating both empathy and an imaginative apparatus for thinking about the relationship between individuals and the community to which they belonged, at the same time establishing the authority of the teacher within their particular small worlds, from classroom to monastery and beyond. Yet, making a success of this intermediary position was not easy and, as we shall see, such victories were often hard won in the face of interference from superiors, competition from peers, and the recalcitrance of audiences.
In thinking about how social control was reproduced over time and space, the problem of agency comes into focus – especially when we consider the position of women. Women had distinctive problems of access to rights and resources in the late ancient world. The constraints imposed on wives and daughters meant that their autonomy in domestic environments was compromised both domestically and in the public sphere. Women had distinctive problems of access to rights and resources, and yet it was a well-known fact that they had their own way of seeing things, and sometimes of helping each other behind the scenes.
Conflict and Social Control in Late Antiquity examines how the cultivation and application of violence across a range of ‘small worlds’ contributed to the making of society in the late Roman period. From households and families to schoolrooms and monasteries, chapters address the different roles that violence played in maintaining and reinforcing the social order, even during a period of intense religious and political change. Elites adopted a range of approaches – formal and informal, legal and illegal, private and public – to keep subordinates in their place. Especially important were the efforts of social elites to inculcate in their followers the idea that the social order was natural rather than contingent, and therefore should not be challenged but rather perpetuated. Chapters focus on written sources from the fourth and fifth centuries, mainly on Christian authors. Collectively, they show that rather than seeking to transform the fortunes of those who were most vulnerable in society (slaves, women, children), such writers drew creatively on pre-existing discursive traditions, in the process reproducing and (occasionally) attempting to mitigate the plight of the downtrodden.
Part II considers how Christian authors addressed the issue of slavery. In the late Roman world, slavery functioned as a fundamental socio-economic framework around which contemporaries organised their lives, conceptually and practically.1 Just as Jonathan Tallon’s chapter in Part I shows how slavery within the household found acceptance, albeit sometimes grudgingly, in the writings of John Chrysostom, so the following chapters demonstrate how slavery was woven into the fabric of Christian society in later antiquity. Christian writers and preachers used metaphors of slavery in order to communicate with their audiences, while slaves were ever-present, if not always recorded, in Christian communities.