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Professor John Geddes has been appointed to the WA Handley Professorship of Psychiatry and will take up this post in November 2021. He will be a fellow of Merton College. A donation from the WA Handley Trust endowed the first Chair of Psychiatry in the University of Oxford’s Department of Psychiatry, which was founded in 1969.
Consenting for themselves: a qualitative study exploring a Gillick Competence assessment to enable adolescents to self-consent to low-risk online research.
BACKGROUND: Providing digital mental health interventions online could expand access to help for young people, but requiring parental consent may be a barrier to participation. We therefore need a method that enables young people <16 years old (ie, presumed competent in the UK) to demonstrate Gillick Competence (understanding of purpose, process, potential benefits and potential harms) to self-consent to online, anonymous, low-risk studies. AIM: To explore whether a new method for assessing Gillick Competence to participate in low-risk, anonymous online studies is acceptable to both young people and parents. METHODS: We interviewed 15 young people aged 13-5 years and 12 parents of this age group in the UK. Using a qualitative approach, we explored the acceptability of a series of multiple-choice questions (MCQs) designed to assess understanding of a specific online self-help research study testing a self-kindness intervention. RESULTS: The MCQ answers that participants gave mostly corresponded with their narrative explanations of their understanding during interviews. Young people and parents thought that the process was empowering and could increase access to research while also promoting independence. However, they emphasised the importance of individual differences and different research contexts and highlighted the need for safeguards to be in place. CONCLUSIONS: The MCQs were acceptable to both young people and parents, providing preliminary evidence for the potential of this process for allowing <16s to self-consent to online, anonymous, low-risk mental health research. Further research is needed to validate the effectiveness of this process among a diverse range of populations and research contexts.
Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial.
BACKGROUND: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. OBJECTIVE: COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. METHODS: We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. RESULTS: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD -1.31, 95% CI -2.51 to -0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD -1.33, 95% CI -2.10 to -0.57; P
"Are we genuinely going to have our voices heard?" The experience of co-producing a blended intervention to prevent relapse in obsessive-compulsive disorder: a qualitative study on the perspectives of experts by lived experience.
INTRODUCTION: Co-production involves researchers, practitioners and people with lived experience working in a collaborative manner, with shared power. The potential benefits of co-production are well documented. However, there is little research describing the experience of having been involved in co-production from the perspective of Experts By Lived Experience (EBLE). The aim of the present study is to explore the experiences of EBLE of obsessive-compulsive disorder (OCD) on their involvement in co-producing a blended intervention to prevent relapse for OCD. METHODS: Five EBLE took part in semi-structured interviews enquiring about their experiences of co-producing a relapse prevention intervention. Reflexive thematic analysis was used to analyse the data. RESULTS: Four themes were developed: (1) Welcome but unexpected therapeutic benefits; (2) The parameters of a safe space; (3) Genuine co-production brings meaningful change; and (4) Navigating the challenging terrain of co-production. CONCLUSIONS: Overall, EBLE reported their involvement in the co-production process to have had positive impacts on both the development of the intervention and their own personal recovery journey. EBLE valued the safety created within the group, and the importance this had for allowing them to speak open and honestly about their experiences and the difficulties that can arise with the nature of the work.
What do they look for and what do they find? A coproduced qualitative study on young people's experiences of searching for mental health information online.
BACKGROUND: Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find. METHOD: We recruited 24 YP (aged 13-18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis. RESULTS: Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking. CONCLUSION: Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.
A systematic review and narrative synthesis of the use and effectiveness of extended reality technology in the assessment, treatment and study of obsessive compulsive disorder
Extended reality (XR) technologies including virtual and augmented reality are seeing increasing research interest in the field of mental health. Obsessive compulsive disorder (OCD) is a condition that remains difficult to assess and treat despite the availability of effective therapies. This systematic review synthesises the current knowledge regarding the use and effectiveness of XR in the assessment, treatment, and study of OCD. The protocol for this review was registered on PROSPERO (ID: CRD42021248021). Searches of six databases were conducted. The xReality framework was used to define which technologies would be included as XR. Studies that recruited analogue samples as well as clinical OCD populations were included. A narrative synthesis of the findings was planned. There was consistent evidence for the use of virtual reality as a tool for symptom provocation in people with contamination-related OCD, as part of exposure and response prevention. Significant heterogeneity exists between study designs found in both symptom provocation and treatment outcome studies. This review has important implications about the narrow focus of research in this area thus far, highlighting the need for further study of different uses of XR in providing positive treatment outcomes across a broader range of OCD symptoms.
Reflection over compliance: Critiquing mandatory data sharing policies for qualitative research.
Many journals are moving towards a 'Mandatory Inclusion of Raw Data' (MIRD) model of data sharing, where it is expected that raw data be publicly accessible at article submission. While open data sharing is beneficial for some research topics and methodologies within health psychology, in other cases it may be ethically and epistemologically questionable. Here, we outline several questions that qualitative researchers might consider surrounding the ethics of open data sharing. Overall, we argue that universal open raw data mandates cannot adequately represent the diversity of qualitative research, and that MIRD may harm rigorous and ethical research practice within health psychology and beyond. Researchers should instead find ways to demonstrate rigour thorough engagement with questions surrounding data sharing. We propose that all researchers utilise the increasingly common 'data availability statement' to demonstrate reflexive engagement with issues of ethics, epistemology and participant protection when considering whether to open data.
"I'm always going to be tired": a qualitative exploration of adolescents' experiences of fatigue in depression.
Adolescent depression is a prevalent and disabling condition, but current psychological treatments are only moderately effective. One way to enhance outcomes is to further our understanding of adolescent depression and improve our capacity to target the most frequently reported and problematic symptoms. A common but often neglected symptom of depression is fatigue, which is associated with considerable impairment and has the potential to interfere with adolescents' engagement in psychological therapies. Despite this, the experience of fatigue in adolescent depression and how we target it in treatment is currently poorly understood. Therefore, we aimed to explore adolescents' experiences and understandings of fatigue in depression, recruiting from clinical and community settings. Semi-structured interviews were conducted with 19 UK-based adolescents aged 14-18 years old with elevated symptoms of depression. Using reflexive thematic analysis, three themes were generated. Fatigue is a complex concept explored adolescents' understanding of fatigue as a dynamic, multifaceted symptom which had mental and physical components. Trapped in a cycle of fatigue considered the complex and reciprocal relationship between fatigue and other depressive symptoms, and the subsequent impact of limited energy on engagement with everyday activities. Finally, stigma as a barrier to help-seeking highlighted how adolescents were reluctant to seek help due to experienced stigma and the perception that fatigue was not a serious enough symptom. Findings from this study suggest that fatigue should be viewed as a psychological as well as somatic symptom of depression, with implications regarding the identification and treatment of fatigue in depression in routine clinical practice.
A qualitative evaluation of mentors’ experiences of a Black, Asian and Minority Ethnic mentor scheme for clinical psychologists
Objectives: Inequalities in the clinical psychology profession extend to the uptake and recruitment of clinical psychologists from Black, Asian, and Minority Ethnic (BAME) backgrounds. Mentoring schemes can help facilitate mentee’s personal and professional development. The aim of this study was to explore the experiences of mentors who participated in the BAME mentor scheme at University of Bath. Methods: Qualitative interviews were conducted with N = 29 mentors (both trainee and qualified clinical psychologists), who predominately identified as female and White British. The reflexive thematic analysis six-step process was employed to analyse the data. Results: Four major themes were generated; (1) Mentoring as a learning curve; (2) Mentoring in the context of BAME; (3) Why we mentor: The impact; and (4) Moving the scheme forward: What next? Conclusions: Overall, mentoring was a rewarding experience for mentors, and given the right support, could help strengthen the mentoring experience and aims of the scheme for the future. These findings offer insight and guidance for future mentoring programmes considering diversifying the clinical psychology profession.
Nonpharmacological interventions for treating fatigue in adolescents: A systematic review and narrative synthesis of randomised controlled trials.
OBJECTIVE: Fatigue is common in adolescence and can be highly disabling if experienced persistently, with adverse psychosocial outcomes. There is a need to better understand what nonpharmacological treatments are available for adolescents suffering with persistent fatigue. The current review systematically identified, synthesised, and evaluated the evidence regarding nonpharmacological interventions for fatigue in adolescents, focusing on evaluating effectiveness, describing intervention components, and mapping interventions onto the behaviour change technique taxonomy (BCTT). METHODS: CENTRAL, EMBASE, PsycINFO, PubMed, and Web of Science were systematically searched for articles including (1) adolescents aged 10-19 years old, (2) fatigue as a primary or secondary outcome, (3) nonpharmacological interventions, and (4) randomised controlled trials. Study screening, data extraction, quality assessment, and BCTT mapping were performed independently by two reviewers. Findings were presented as a narrative synthesis, with interventions ranked by promise. RESULTS: 5626 papers were identified and double-screened, resulting in the inclusion of 21 articles reporting 16 trials. Five interventions were classified as likely promising. Interventions often involved psychoeducation, cognitive behavioural therapy, and/or physical activity, incorporating various BCTT domains, most commonly shaping knowledge, repetition and substitution, and goals and planning. However, there did not seem to be any observable differences between fatigue-targeted and non-fatigue-targeted interventions. Overall study quality was mixed, particularly in relation to power and outcome measures. CONCLUSION: There are several promising nonpharmacological interventions for adolescent fatigue, although further work is needed to determine effectiveness. Future trials need to ensure design rigour, focusing on adequate powering, validated outcome measures, and adhering to best practice reporting guidelines.
Loneliness and mental health in children and adolescents with pre-existing mental health problems: A rapid systematic review.
OBJECTIVES: Periods of social isolation are associated with loneliness in children and young people, and loneliness is associated with poor mental and physical health. Children and young people with pre-existing mental health difficulties may be prone to loneliness. Containment of COVID-19 has necessitated widespread social isolation, with unprecedented school closures and restrictions imposed on social interactions. This rapid review aimed to establish what is known about the relationship between loneliness and mental health problems in children and young people with pre-existing mental health problems. METHODS: We sought to identify all primary research that examined the cross-sectional and longitudinal associations between loneliness/perceived social isolation and mental health in children and young people with pre-existing mental health problems. We also aimed to identify effective interventions that reduce the adverse impact of loneliness. A rapid systematic search was conducted using MEDLINE, PsycINFO, and Web of Science. RESULTS: Of 4,531 papers screened, 15 included children and young people with pre-existing mental health conditions. These 15 studies included 1,536 children and young people aged between 6 and 23 years with social phobia, anxiety and/or depression, and neurodevelopmental disorders. Loneliness was associated with anxiety and depression both cross-sectionally and prospectively in children and young people with mental health problems and neurodevelopmental conditions. We found preliminary evidence that psychological treatments can help to reduce feelings of loneliness in this population. CONCLUSIONS: Loneliness is associated with depression and anxiety in children and young people with pre-existing mental health conditions, and this relationship may be bidirectional. Existing interventions to address loneliness and/or mental health difficulties in other contexts may be applied to this population, although they may need adaptation and testing in younger children and adolescents. PRACTITIONER POINTS: Loneliness is common in children and young people, and during periods of enforced social isolation such as during COVID-19, children and young people report high levels of loneliness (or increased rates of loneliness). The review showed that loneliness is associated, both cross-sectionally and prospectively, in children and young people with mental health problems and also in children and young people with neurodevelopmental conditions, such as autism spectrum disorder. Thus, loneliness is a possible risk factor of which mental health providers should be aware. Maintaining social contact both by direct and by indirect means, especially through the Internet, could be important in mitigating loneliness. Interventions to address loneliness should be further developed and tested to help children and young people with pre-existing mental health problems who are lonely by preventing exacerbation of their mental health difficulties, in particular anxiety and depression.
‘Who Could Help me? There was Nothing. I Brought it on Myself’: A Qualitative Study Exploring UK University Student Experiences of Sexual Violence
This article includes content about sexual violence, rape culture and narratives of victim blaming that some people may find upsetting or unsettling. We advise you to continue reading at your discretion.Research suggests that university students are disproportionately affected by sexual violence and that most incidents remain unreported. Little qualitative research has been conducted to explore this further in the context of the UK. The current study used qualitative semi-structured interviews to explore the lived experiences of 11 university students currently studying at UK institutions, with data analysed used reflexive thematic analysis. Three key themes were generated, which collectively narrate the decision-making progress students navigate after experiencing sexual violence: (1) Making sense of sexual violence; (2) Barriers to disclosure; and (3) Navigating support. Three key take-home messages are outlined.
The experience of cognitive behavioural therapy in depressed adolescents who are fatigued.
OBJECTIVE: Fatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD. DESIGN: A qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study. METHODS: Data were obtained from semi-structured interviews conducted after therapy. Participants were 18 adolescents (aged 13-18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis. RESULTS: Three themes and seven sub-themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled adolescents to open up in sessions. When the therapist was not perceived as genuine, adolescents appeared to find CBT less helpful. The structure of CBT appeared to enable treatment goals to be set, and facilitated an increase in meaningful activity. Ensuring that tasks were perceived as manageable and goals as achievable seemed important for participation. Cognitive restructuring appeared useful, although some adolescents tended to engage in distraction from thoughts as an alternative strategy. CONCLUSIONS: This study provides an initial insight into how fatigued adolescents with MDD experience CBT. Further research is required to establish whether the themes are pervasive and relatedly, how best to treat depression in fatigued adolescents receiving CBT. PRACTITIONER POINTS: Fatigued adolescents with depression found engaging in CBT sessions and therapeutic homework demanding. Establishing a collaborative therapeutic relationship, where the therapist was perceived as genuine, appeared helpful for participation. The structured approach to therapy, combined with flexibility, was experienced as helpful. Adolescents who perceived the pace of sessions to be manageable and therapeutic goals as achievable seemed to find CBT helpful overall. These findings provide insight into how fatigued adolescents with depression experience CBT and highlight the importance of being aware of fatigue and adapting therapy accordingly.
A TALE OF TWO HATS: TRANSFORMING FROM THE RESEARCHED TO THE RESEARCHER
In this collaborative essay, three PhD students working in disciplines across the social sciences share their personal reflections on transforming from ‘researched’ to ‘researcher’, with reference to ‘insider’ perspectives. This position departs from traditional post-positivist assumptions of researchers as unbiased and detached from their work, and instead embraces the inherent impact their lived experiences will have. Decades of scholarship within the social sciences have highlighted the advantages afforded by insider positionality, particularly in terms of knowledge production and participant recruitment. Such a position challenges and even transforms the research relationship; still, despite the potentiality it holds, there are many challenges faced by insider researchers, and personal reflections on how this position is navigated are few and far between, particularly from a student perspective. In this essay, we share candid accounts of our experiences in this unique position and reflect on how we have navigated the challenges that have occurred. We conclude by highlighting commonalities between our experiences and identify three key messages we wish for other early-career academics in similar positions to hear.
How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for these mental health co-morbidities? A clinical cohort study.
Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12-18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children's Anxiety and Depression Scale, RCADS; Spence Children's Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC > 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment.