CoDesign of a digital intervention for parents with bipolar disorder informed by integrated knowledge translation principles.

OBJECTIVES: To provide detailed information on the codesign of a digital intervention to support parents with bipolar disorder (BD) who have young children. Each step of this process is reported, as well as a detailed description of the final version of the intervention in line with the TIDieR framework. METHODS: Clinical experience and lived experience experts participated in online workshops, meetings, and remote feedback requests, informed by Integrated Knowledge Translation (IKT) principles. The IKT research group responded to each phase of recommendations from the knowledge users. RESULTS: Five clinical experience experts and six lived experience experts engaged with the codesign process. Their recommendations for principles, content, look, and feel, and functionality of the digital intervention were structured over five iterative phases. This led to a final implemented design that was identified by the clinical and lived experience experts (referred to together as the knowledge users group) as genuinely reflecting their input. CONCLUSIONS: The IKT principles offer an accessible structure for engaging with clinical and lived experience experts throughout a codesign process, in this case for a digital intervention for parents with BD. The resulting intervention is described in detail for transparency to aid further evaluation and development and to help other teams planning codesign approaches to intervention development.

The relationship between childhood adversity and affective instability across psychiatric disorders: A meta-analysis.

INTRODUCTION: Affective instability represents an important, transdiagnostic biobehavioural dimension of mental ill health and clinical outcome. The causes of affective instability remain unclear. This systematic review and meta-analysis evaluated the extent to which exposure to childhood adversity is associated with affective instability across psychiatric disorders, and which forms of adversity are most strongly associated with affective instability. METHODS: The review followed a published protocol (PROSPERO: CRD42020168676). Searches in Medline, Embase and PsychInfo identified studies using quantitative measures of childhood adversity and affective instability, published between January 1980 and July 2023. Data were analysed using a random effects meta-analysis separately for each outcome, namely affective lability, emotion dysregulation, and rapid cycling. The Mixed-Methods Appraisal Tool was used to appraise the quality of the literature. RESULTS: The search identified 36 studies involving 8431 participants. All reports focused on cross-sectional associations. We did not identify any prospective longitudinal research. The analysis showed small, but statistically significant effects of childhood adversity on affective lability (r = 0.09, 95% CI 0.02, 0.17), emotion dysregulation (r = 0.25, 95% CI 0.19, 0.32), and rapid cycling (OR = 1.39; 95% CI 1.14, 1.70). When considering adversity subtypes, emotional abuse showed the strongest effect on affective lability (r = 0.16, 95% CI 0.07, 0.24) and emotion dysregulation (r = 0.32, 95% CI 0.19, 0.44). Quality assessment scores were generally low. Most studies failed to control for confounding factors or offer assurances around the representativeness of the samples. CONCLUSIONS: The findings suggest that childhood adversity, particularly emotional abuse, is associated emotional instability in adulthood, but further prospective longitudinal research is needed to confirm causality. The findings have implications for the prevention and treatment of affective instability across psychiatric disorders.

Developing a Consensus Statement to Target Oral Health Inequalities in People With Severe Mental Illness.

INTRODUCTION: Oral diseases are more prevalent in people with severe mental illness (SMI) compared to those without mental illnees. A greater focus on oral health is needed to reverse unacceptable but often neglected oral health inequality in people with SMI. This provided the impetus for developing 'The Right to Smile' consensus statement. We aimed to develop and disseminate a consensus statement to address oral health inequality, highlighting the main areas for concern and recommending an evidence-based 5-year action plan to improve oral health in people with SMI. METHODS: The Right to Smile consensus statement was developed by experts from several professional disciplines and practice settings (mental, dental and public health) and people with lived experience, including carers. Stakeholders participated in a series of online workshops to develop a rights-based consensus statement. Subsequent dissemination activities were conducted to maximise its reach and impact. RESULTS: The consensus statement was developed to focus on how oral health inequalities could be addressed through a set of 5-year improvement targets for practice, policy and training. The consensus was reached on three 5-year action plans: 'Any assessment of physical health in people experiencing SMI must include consideration of oral health', 'Access to dental services for people with SMI needs to improve' and 'The importance of oral health for people experiencing SMI should be recognised in healthcare training, systems, and structures'. CONCLUSION: This consensus statement urges researchers, services and policymakers to embrace a 5-year action plan to improve oral health for people with SMI. PATIENT OR PUBLIC CONTRIBUTION: The team included people with lived experience of SMI, their carers/family members and mental and dental health service providers. They were involved in every stage of developing the consensus statement, from conception to development and dissemination.

Quality of life in older adults with mood states associated with bipolar disorder: A secondary analysis of the English longitudinal study of ageing data.

OBJECTIVES: To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder. METHODS: The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure. RESULTS: The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group. CONCLUSIONS: Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.

The Changing Care of Older Adults With Bipolar Disorder: A Narrative Analysis.

Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants' accounts led to the creation of four themes: (1) 'Navigating the disruption caused by diagnosis'; (2) 'The removal of services that provided hope'; (3) 'Later life: We are on our own now'; and (4) 'Changing care needs in later life: We still need support'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.

Lived experience at the core: A classification system for risk-taking behaviours in bipolar.

Objective: Clinical observations suggest that individuals with a diagnosis of bipolar face difficulties regulating emotions and impairments to their cognitive processing, which can contribute to high-risk behaviours. However, there are few studies which explore the types of risk-taking behaviour that manifest in reality and evidence suggests that there is currently not enough support for the management of these behaviours. This study examined the types of risk-taking behaviours described by people who live with bipolar and their access to support for these behaviours. Methods: Semi-structured interviews were conducted with n = 18 participants with a lived experience of bipolar and n = 5 healthcare professionals. The interviews comprised open-ended questions and a Likert-item questionnaire. The responses to the interview questions were analysed using content analysis and corpus linguistic methods to develop a classification system of risk-taking behaviours. The Likert-item questionnaire was analysed statistically and insights from the questionnaire were incorporated into the classification system. Results: Our classification system includes 39 reported risk-taking behaviours which we manually inferred into six domains of risk-taking. Corpus linguistic and qualitative analysis of the interview data demonstrate that people need more support for risk-taking behaviours and that aside from suicide, self-harm and excessive spending, many behaviours are not routinely monitored. Conclusion: This study shows that people living with bipolar report the need for improved access to psychologically informed care, and that a standardised classification system or risk-taking questionnaire could act as a useful elicitation tool for guiding conversations around risk-taking to ensure that opportunities for intervention are not missed. We have also presented a novel methodological framework which demonstrates the utility of computational linguistic methods for the analysis of health research data.

Investigating the Relationship between Oral Health and Severe Mental Illness: Analysis of NHANES 1999-2016.

OBJECTIVES: To explore whether: (i) people with severe mental illness (SMI) experience worse oral health than the general population, and (ii) the risk factors for poor oral health in people with SMI. METHODS: Cross-sectional data were extracted from the National Health and Nutrition Examination Survey (1999-2016), including on self-rated oral health, oral pain, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. Ordinal logistic regression and zero-inflated negative binomial models were used to explore predictors of oral health outcomes. RESULTS: There were 53,348 cases included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.60, 95% CI: 1.34-1.92). In people with SMI, risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes. CONCLUSIONS: People with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Performing regular physical exercise and flossing may lower the risk of poor oral health, while smoking and diabetes may increase the risk. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes in people with SMI.