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Journal article

On the reciprocal effects between multiple group identifications and mental health: a longitudinal study of Scottish adolescents

Authors:
MILLER Kirsty, WAKEFIELD Juliet R.H., SANI Fabio
Journal article citation:
British Journal of Clinical Psychology, 56(4), 2017, pp.357-371.
Publisher:
Wiley-Blackwell

Objectives: The aim of the study was to investigate the link between social group identification and mental health outcomes in a sample of secondary school pupils. Based on previous work, it was predicted that multiple high group identifications would protect against psychological ill health. Furthermore, it was predicted that better mental health would also predict greater number of group identifications, thus creating a ‘virtuous circle’. Design: A longitudinal questionnaire design was used. Methods: A total of 409 Scottish secondary school pupils aged 13–17 completed a questionnaire twice over a year. Pupils’ responses regarding their mental health and the extent of their identification with three groups (the family, school, and friends) were measured. Results: A path analysis of the data showed that greater number of high group identifications predicted better mental health outcomes amongst participants. However, better mental health also predicted greater number of high group identifications, suggesting that there is a cyclical relationship between both variables. Conclusions: The findings have both theoretical and practical implications. They highlight the importance of conceptualising the link between group identification and mental health as cyclical, rather than unidirectional. This reconceptualisation has implications for mental health promotion strategies, as it highlights the importance of attempting to turn a potentially ‘vicious cycle’ of social disidentification and mental ill health into a ‘virtuous cycle’ of social identification and mental health. Practitioner points: 1) Results showed that in a population of 409 high school pupils, the more high group identifications pupils had, the better their mental health outcomes. Better mental health also predicted a greater number of high group identifications over time; 2) The findings suggest that we would benefit from conceptualising the relationship between group identification and mental outcomes as being cyclical rather than unidirectional; 3) Viewing the relationship between group identification and mental health in this way enables us to consider interventions which help turn a ‘vicious cycle’ into a ‘virtuous cycle’. Limitations: 1) A potential limitation of the work relates to the use of self-report questionnaires which may elicit socially desirable responses; 2) The sample only consists of high school pupils from mainstream public schools within Scotland. (Publisher abstract)

Journal article

A sequence analysis of patterns in self-harm in young people with and without experience of being looked after in care

Authors:
WADMAN Ruth, et al
Journal article citation:
British Journal of Clinical Psychology, 56(4), 2017, pp.388-407.
Publisher:
Wiley-Blackwell

Objectives: Young people in the public care system (‘looked-after’ young people) have high levels of self-harm. Design: This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). Methods: Young people in care (looked-after group: n = 24; 14–21 years) and young people who had never been in care (contrast group: n = 21; 13–21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months. Results: Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm. Conclusions: Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended. Practitioner points: 1) Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this; 2) Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm; 3) Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm; 4) Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted. The CaTS would have clinical utility as an assessment tool; 5) Recruiting participants can be a significant challenge in studies with looked-after children and young people; 6) Future research with larger clinical samples would be valuable. (Publisher abstract)

Journal article

Associations between behaviours that challenge in adults with intellectual disability, parental perceptions and parental mental health

Authors:
WAITE Jane, et al
Journal article citation:
British Journal of Clinical Psychology, 56(4), 2017, pp.408-430.
Publisher:
Wiley-Blackwell

Objectives: This study examined parental perceptions of behaviours that challenge (CB) in their adult children with intellectual disability (ID), and explored whether perceptions mediated associations between CB and parental psychological distress. Design: A within-group correlational design was employed. Methods: Sixty-five parents reported on individuals with genetic syndromes and ID who had chronic CB. Parents completed the Illness Perception Questionnaire-Revised (IPQ-R) adapted to measure perceptions of self-injury, aggression or property destruction, alongside assessments of parental locus of control, attributions about behaviour, parental psychological distress, and CB. Results: A high proportion of parents evidenced anxiety and depression at clinically significant levels (56.9% and 30.8%, respectively). Contrary to predictions, psychological distress was not significantly associated with CB. The perception that the adult with ID exerted control over the parent's life mediated the association between CB and parental psychological distress. Few parents endorsed operant reinforcement as a cause of CB (< 10%). Conclusions: The high levels of psychological distress in parents is notable and of concern. Further research should consider the reasons why parents have causal attributions that might be inconsistent with contemporary interventions. Practitioner points: 1) Parents experience high levels of psychological distress while supporting adults with ID who engage in chronic behaviours that challenge; 2) A stronger belief that the adult with ID exerts control over the parent's life may mediate an association between CB exhibited by the individual with ID and parental psychological distress; 3) Few parents endorsed operant reinforcement as a cause of behaviours that challenge. (Publisher abstract)

Journal article

Does fathers’ and mothers’ rumination predict emotional symptoms in their children?

Authors:
PSYCHOGIOU Lamprini, et al
Journal article citation:
British Journal of Clinical Psychology, 56(4), 2017, pp.431-442.
Publisher:
Wiley-Blackwell

Objectives: Although rumination can have a negative influence on the family environment and the quality of parent–child interactions, there is little research on the role of parental rumination in predicting adverse child outcomes over time. This longitudinal study examined whether mothers’ and fathers’ brooding rumination would each uniquely predict emotional symptoms in preschool children. Methods: The initial sample consisted of 160 families (including 50 mothers with past depression, 33 fathers with past depression, and 7 fathers with current depression according to the Structural Clinical Interview for DSM-IV). Families were seen at two times separated by 16 months. Children's mean age at the entry into the study was 3.9 years (SD = 0.8). Each parent independently completed the Ruminative Response Scale, the Child Behavior Checklist, the Patient Health Questionnaire, and the Dyadic Adjustment Scale. Results: Fathers’ brooding rumination significantly predicted children's emotional symptoms over 16 months when controlling for child emotional symptoms, couple adjustment, parents’ depressive symptoms, mothers’ brooding and reflective rumination, and fathers’ reflective rumination at baseline. Unexpectedly, mothers’ brooding rumination did not significantly predict child emotional symptoms over time. Correlational analyses showed significant associations between parents’ rumination and lower levels of couple adjustment. Conclusions: Findings suggest that fathers’ brooding rumination may play a unique role in their children's emotional outcomes. If these findings are replicated, studies should examine the processes by which these links occur and their implications for clinical interventions. Practitioner points: 1) Rumination is prevalent among individuals with depression, but to date no studies have examined the possible role of mothers’ and fathers’ brooding rumination in predicting children's emotional symptoms; 2) Fathers’ brooding rumination was positively associated with children's emotional symptoms over time when controlling for mothers’ rumination and other important characteristics; 3) Parental rumination might be a promising target for both prevention and intervention strategies for parents with depression and their children; 4) The findings of this study could inform parenting interventions (e.g., educate parents about the possible effects of rumination on family interactions and children's outcomes, help parents notice when they ruminate, teach them to replace rumination with more adaptive strategies); 5) The findings should be interpreted with caution. The study relied on self-reports, and therefore, the data are subject to shared method variance which may have artificially inflated associations between parent and child outcomes; 6) The sample consisted of well-educated parents, and therefore, the findings should be generalised to other populations with caution. (Publisher abstract)

Journal article

Choir singing and creative writing enhance emotion regulation in adults with chronic mental health conditions

Authors:
DINGLE Genevieve A., et al
Journal article citation:
British Journal of Clinical Psychology, 56(4), 2017, pp.443-457.
Publisher:
Wiley-Blackwell

Objectives: Adults with mental health conditions commonly experience difficulties with emotion regulation which affect their social functioning. Arts-based groups provide opportunities for shared emotional experiences and emotion regulation. This study explores emotion regulation strategies and the emotional effects of arts-based group participation in adults with mental health problems and in controls. Design and method: The 62 participants included 39 adults with chronic mental health problems who were members of arts-based groups (ABG) and 23 comparison choir (CC) members who were not specifically experiencing mental health problems. The repeated measures design included self-reports of emotion upon waking (T1), the hour before group (T2), end of the group (T3), and evening (T4), as well as participant notes to explain their emotion ratings at each time. They also completed measures of individual and interpersonal emotion regulation. Results:The ABG participants engaged marginally more in affect worsening strategies than CC (p = .057 and .08), but there were no other group differences. All participants reported a significant increase in positive emotions, F (3, 180) = 28.044, p < .001, math formula = .319; and a decrease in negative emotions during the arts-based activity: F (2.637, 155.597) = 21.09, p < .001, math formula = .263. The influence on positive emotions was short-lived, while the effect on negative emotions lasted until evening. Conclusion: Findings show that participation in arts-based groups benefits the emotions of both healthy adults and those experiencing mental health conditions through individual and interpersonal processes. Practitioner points: 1) Individuals with chronic mental health conditions often experience difficulties in emotion processing; 2) Participation in arts-based groups was associated with significant increases in positive emotions although these were short-lived; 3) Negative emotion was significantly decreased during arts-based group activities, and sustained to the evening assessment; 4) Adults with chronic mental health conditions were equally able to derive emotional benefits as healthy adults (Publisher abstract)

Journal article

Personality and behavioural changes do not precede memory problems as possible signs of dementia in ageing people with Down syndrome

Authors:
BLOK J.B., SCHEIRS J.G.M., THIJM N.S.
Journal article citation:
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1257-1263.
Publisher:
Wiley-Blackwell

Objective: The objective was to find out whether changes in personality and adaptive functioning or memory processes decline first in ageing people with Down syndrome. Methods: The authors measured these variables cross-sectionally in a Dutch sample (22 to 62 years of age) of 68 institutionalised people with Down syndrome. Results: The scores on all the variables except one of the temperament scales were found to decline gradually with increasing age, but deterioration of episodic memory started earlier. Conclusions: The authors argued that a subset of their sample suffered from dementia. Furthermore, the data suggested that immediate memory impairment is one of the earliest signs of the disease in people with Down syndrome, just as it is in the general population. (Edited publisher abstract)

Journal article

Aging perceptions and self-efficacy mediate the association between personality traits and depressive symptoms in older adults

Authors:
O'SHEA D.M., DOTSON V.M., FIEO R.A.
Journal article citation:
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1217-1225.
Publisher:
Wiley-Blackwell

Objective: Personality traits have been shown to be predictors of depressive symptoms in late life. The authors examined whether other more modifiable sources of individual differences such as self-efficacy and self-perceptions of ageing would mediate the association between personality traits and depressive symptoms in older adults. Method: Data were obtained from 3,507 older adult participants who took part in the 2012 Health and Retirement Study. The “Big Five” personality traits, self-efficacy, ageing perceptions, and depressive symptoms were assessed. Mediation analyses tested the hypothesis that self-efficacy and ageing perceptions would mediate the relationship between personality traits and depressive symptoms. Results: All five personality traits were significant predictors of depressive symptoms. Neuroticism was positively associated with depressive symptoms and had the greatest effect compared with the other personality traits. There was a significant indirect effect of neuroticism, extraversion, and conscientiousness on depressive symptoms (including both mediators). The mediating effect of ageing perceptions on the relationship between neuroticism and depressive symptoms was the strongest compared with self-efficacy, accounting for approximately 80% of the total indirect effect. Conclusion: The authors results provide support for interventions aimed at improving self-perceptions related to efficacy and ageing in order to reduce depressive symptoms in older adults. (Edited publisher abstract)

Journal article

The cost of care homes for people with dementia in England: a modelling approach

Authors:
ROMEO Renee, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1466-1475.
Publisher:
Wiley-Blackwell

Objectives: To examine the cost of care for people with dementia in institutional care settings, to understand the major cost drivers and to highlight opportunities for service development. Methods: Data on 277 residents with dementia in 16 UK residential or nursing homes were collected. The authors estimated care and support costs and fitted models to the data. Sensitivity analyses were also conducted. Results: Care home residents cost £792 weekly: 95% of the costs accounted for by direct fees. Hospital contacts contributed the largest proportion of the additional costs. Having an established diagnosis of dementia (b = 0.070; p < 0.05) was associated with higher costs. No association was found between cost and needs (b = −0.002; p = 0.818). Conclusion: The absence of an association between cost and needs emphasises the importance of a more needs-based costing system which could result in clinical and economic advantages. (Edited publisher abstract)

Journal article

Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study

Authors:
KURONEN Marja, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1418-1424.
Publisher:
Wiley-Blackwell

Background: Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. Methods: Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. Results: The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14–3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18–2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44–0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45–0.90) and higher ADL score (OR 0.9, 95% CI 0.92–0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. Conclusions: More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. (Publisher abstract)

Journal article

Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care

Authors:
TONG Thaison, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1392-1400.
Publisher:
Wiley-Blackwell

Introduction: The authors estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. Methods: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Results: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Conclusions: The analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. (Edited publisher abstract)

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