Academic and non-academic predictors of common mental health difficulties among university students during the COVID-19 pandemic.

Introduction: Public concern for the mental health of university students has been rising over recent years. Newly arising stressors associated with the COVID-19 pandemic could contribute to further mental health burden for students. This study aimed to understand the mental health status of university students at an early stage in the pandemic and to identify academic, non-academic, and COVID-19-related predictors of common mental health difficulties at this time. Methods: This study examined how academic and non-academic predictors relate to common mental health difficulties using a cross-sectional sample of university students (n = 3817). Results: There were high levels of depression and anxiety during the pandemic, with more than 50% experiencing levels above the clinical cut offs. Academic stress, social isolation, intolerance of uncertainty, and more negative attitudes towards remote teaching and learning predicted higher levels of depression and anxiety. University identification predicted lower levels of depression whereas receiving a diagnosis of COVID-19 was associated with higher levels of depression. Discussion: This study identified COVID-19-related factors that uniquely contributed to students' distress during the pandemic, over and above social connectivity variables. As COVID-19 factors, such as the uncertainty surrounding the pandemic, may have driven an increase in distress levels among students, these findings provide insights that could help universities and policymakers develop targeted interventions to support the mental health and well-being of university students during future crises.

Unravelling the dynamics of mental health inequalities in England: A 12-year nationwide longitudinal spatial analysis of recorded depression prevalence.

Background: Depression is one of the most significant public health issues, but evidence of geographic patterns and trends of depression is limited. We aimed to examine the spatio-temporal patterns and trends of depression prevalence among adults in a nationwide longitudinal spatial study in England and evaluate the influence of neighbourhood socioeconomic deprivation in explaining patterns. Methods: Information on recorded depression prevalence was obtained from the indicator Quality and Outcomes Framework: Depression prevalence that measured the annual percentage of adults diagnosed with depression for Lower Super Output Areas (LSOA) from 2011 to 2022. We applied Cluster and Outlier Analysis using the Local Moran's I algorithm. Local effects of deprivation on depression in 2020 examined with Geographically Weighted Regression (GWR). Inequalities in recorded prevalence were presented using Prevalence Rate Ratios (PRR). Results: The North West Region of England had the highest concentration of High-High clusters of depression, with 17.4% of the area having high values surrounded by high values in both space and time and the greatest percentage of areas with a high rate of increase (43.1%). Inequalities widened among areas with a high rate of increase in prevalence compared to those with a lower rate of increase, with the PRR increasing from 1.66 (99% CI 1.61-1.70) in 2011 to 1.81 (99% CI 1.76-1.85) by 2022. Deprivation explained 3%-39% of the variance in depression in 2020 across the country. Conclusions: It is crucial to monitor depression's spatial patterns and trends and investigate mechanisms of mental health inequalities. Our findings can help identify priority areas and target prevention and intervention strategies in England. Evaluating mental health interventions in different geographic contexts can provide valuable insights to policymakers on the most effective and context-sensitive strategies, enabling them to allocate resources towards preventing the worsening of mental health inequalities.

Pilot Evaluation of a Remote Psychotherapy Service for Students Who Self-Harm: University-Community Outpatient Psychotherapy Engagement (U-COPE).

Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University-Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students' and practitioners' experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: 'Accessibility'; 'Therapeutic experiences'; and 'Spaces and places of therapy'. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.

COVID-19 risk mitigation in reopening mass cultural events: population-based observational study for the UK Events Research Programme in Liverpool City Region.

OBJECTIVES: To understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks, perceived risks and the feasibility of risk mitigations from experimental mass cultural events before coronavirus disease 2019 (COVID-19) restrictions were lifted. DESIGN: Prospective, population-wide observational study. SETTING: Four events (two nightclubs, an outdoor music festival and a business conference) open to Liverpool City Region UK residents, requiring a negative lateral flow test (LFT) within the 36 h before the event, but not requiring social distancing or face-coverings. PARTICIPANTS: A total of 12,256 individuals attending one or more events between 28 April and 2 May 2021. MAIN OUTCOME MEASURES: SARS-CoV-2 infections detected using audience self-swabbed (5-7 days post-event) polymerase chain reaction (PCR) tests, with viral genomic analysis of cases, plus linked National Health Service COVID-19 testing data. Audience experiences were gathered via questionnaires, focus groups and social media. Indoor CO2 concentrations were monitored. RESULTS: A total of 12 PCR-positive cases (likely 4 index, 8 primary or secondary), 10 from the nightclubs. Two further cases had positive LFTs but no PCR. A total of 11,896 (97.1%) participants with scanned tickets were matched to a negative pre-event LFT: 4972 (40.6%) returned a PCR within a week. CO2 concentrations showed areas for improving ventilation at the nightclubs. Population infection rates were low, yet with a concurrent outbreak of >50 linked cases around a local swimming pool without equivalent risk mitigations. Audience anxiety was low and enjoyment high. CONCLUSIONS: We observed minor SARS-CoV-2 transmission and low perceived risks around events when prevalence was low and risk mitigations prominent. Partnership between audiences, event organisers and public health services, supported by information systems with real-time linked data, can improve health security for mass cultural events.

Experiences of Remote Provision across a Voluntary Sector Organisation Providing Mental Health and Wellbeing Services for Young People.

The global COVID-19 pandemic presented not only challenges for services but also opportunities for reflection and change. This study aimed to understand young people, parents/carers, and professionals' experiences of remote provision across a voluntary sector organization to inform the nature of future delivery. Reflections from professionals (n = 7), young people (n = 7), and parents/carers (n = 2) were collected through semi-structured interviews and focus groups. Data were thematically analysed. Five overarching themes were identified: 'Accessibility', 'Remote therapeutic experiences', 'Translating to online', 'Spaces of comfort/discomfort', and 'Moving towards hybrid provision'. The COVID-19 pandemic changed service provision, notably with accelerated digitalisation. Although the service became more accessible, the digitalisation of services impacted the relational experiences for young people. Nevertheless, online provision was described as a 'steppingstone', allowing young people to engage in online therapy or group programmes before transferring to in-person provision. Although remote provision can lead to improvements in young people's mental health, this format was not suitable for all. When considering future models of provision, assessing needs, preferences, and access to private space and hardware are all important considerations when deciding which format to use to achieve the best possible outcomes.

Exploring the different cognitive, emotional and imaginative experiences of autistic and non-autistic adult readers when contemplating serious literature as compared to non-fiction.

Introduction: Recent research has demonstrated how reflections on serious literature can challenge dominant social-deficit views of autism. This method enables autistic readers to explore social realities more slowly and carefully, encouraging detail-focused considerations. Previous research has also shown that autistic and non-autistic readers reflecting on serious literature together are able to achieve mutuality in a way that enables them to overcome the double empathy problem. However, the advantages of reading aloud designs have yet to be explored with autistic and non-autistic readers due to previous concerns amongst autistic people on the issue of being read aloud to. The present study aimed to explore how an adapted shared reading design that compared serious literature and non-fiction would enable autistic and non-autistic readers to imaginatively engage in the reading experience. Methods: Seven autistic and six non-autistic participants read 8 short text extracts alone while listening to pre-recorded audio of an experienced reader reading each text aloud. Participants completed a reflective questionnaire for each text and a follow-up interview where moving parts of the text were then re-read aloud before discussion. Half of these texts were serious literature, while the other half were non-fiction. Similarly, half of the texts explored fictional social realities that depicted a lack of mutuality, or non-fiction accounts of autism; while the other half explored broader emotional experiences. Results: Thematic and literary analysis of participant reflections and follow-up interviews revealed three main themes: (1) From Surface Reading to Intuitive Engagement, (2) Imaginative Feeling and (3) Going Forward from the Reading Experience. Discussion: The findings showed that autistic readers were better able to hold onto the detailed complexity of serious literature, while non-autistic readers tended to reduce information down to key ideas and understandings for later generalization. Findings are discussed in relation to future shared reading designs.

Psychopathic traits and theory of mind task performance: A systematic review and meta-analysis.

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by factors such as age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate between self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy.

Longitudinal investigation of the presence of different trajectories and associated health and socio-economic determinants, for participants who report suicidal ideation within a community-based public health survey.

OBJECTIVE: Given the paucity of evidence-based research investigating different suicidal ideation profiles and trajectories, this project sought to investigate health and socio-economic factors associated with the presence of suicidal ideation and changes in ideation over time. DESIGN: Longitudinal cohort design, using logistic regression analysis. SETTING: A public health survey was administered at two timepoints in a community setting across the North West of England. In the 2015/2016 survey, participants were recruited from high (n=20) and low (n=8) deprivation neighbourhoods. In the 2018 survey, only the 20 high-deprivation neighbourhoods were included. PARTICIPANTS: 4287 people were recruited in 2015/2016 and 3361 were recruited in 2018. The 2018 sample was subdivided into those who responded only in 2018 (n=2494: replication sample) and those who responded at both timepoints (n=867: longitudinal sample). PRIMARY OUTCOME MEASURES: Suicide ideation was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire instrument. RESULTS: The prevalence of suicidal ideation was 11% (n=454/4319) at 2015/2016 and 16% (n=546/3361) at 2018.Replication study results highlighted: persistent debilitation from physical ill health and/or medication side effects; demographic factors (ie, middle-aged, single or never married); and personal coping strategies (ie, smoking) as risk factors for suicidal ideation. A static/improved financial position and high levels of empathy were protective factors.Longitudinal study results confirmed three suicidal ideation trajectories: 'onset', 'remission' and 'persistence'. Similar findings to the replication study were evidenced for the onset and persistence trajectories. Persistent suicidal ideation was synonymous with higher levels of practical support which may correspond to the higher levels of debilitation and functional disability reported within this group. Remission was characterised by fewer debilitating factors and higher levels of self-agency. CONCLUSION: A greater appreciation of the heterogeneity of suicidal trajectories should lead to the implementation of broad clinical assessments and targeted interventions.

Poverty, ACEs and stigmatised places: The application of psychology to the challenges of disadvantage.

BACKGROUND: Our life circumstances present continual challenges to our mental health and well-being. For most of us, the politics of economy and society determine our prospects of living a good life. The fact that the ability to control and change things that happen to us is largely vested in the power of remote others has inevitable, mostly negative consequences. METHOD: The following opinion piece illustrates the challenge our discipline faces in locating a complimentary contribution alongside those of public health, sociology and other sister disciplines with particular reference to the intractable concerns of poverty, ACES and stigmatised places. FINDINGS: The piece presents an examination of what psychology as a discipline can do in the context of adversity and challenges that individuals face but over which they have little sense of control. The discipline of psychology needs to play a meaningful part in understanding and addressing the impacts of societal matters, moving from a dominant position of individualised understandings of distress to embrace more fully the context in which people are expected to feel good and function well. CONCLUSION: Community psychology offers a useful, established philosophy from which to advance our practices. However, a more sophisticated, discipline-wide narrative and grounded understanding that empathically represents real lives and captures individual functioning within a complex and distant societal system is urgently required.

'Looking before and after': Can simple eye tracking patterns distinguish poetic from prosaic texts?

Introduction: The study of 'serious' literature has recently developed into an emerging field called neurocognitive poetics that applies cognitive neuroscientific techniques to examine how we understand and appreciate poetry. The current research used eye-tracking techniques on a small sample of young adults to see if and how the reading of short pieces of poetry differed from the reading of matched prosaic texts. Methods: With 'proof of concept' intentions reflecting arguments first proposed by 19th Century literary figures, there was a particular focus on the differences between the reading of poetry and prose in terms number and frequency of fixations and regressive eye movements back and forth within the texts in this two-by-two experimental design (poetry vs. prose x need vs. no need for final line reappraisal). Results: It was found that poetic pieces compared to prosaic pieces were associated with more and longer fixations and more regressive eye movements throughout the text. The need to reappraise meaning at the prompt of a final line was only significantly associated with more regressive eye movements. Comparisons examining the 4 text conditions (poetic reappraisal, poetic non-reappraisal, prosaic reappraisal, and prosaic non-reappraisal) showed that the poetic reappraisal condition was characterised by significantly more regressive eye movements as well as longer fixations compared to the prosaic non-reappraisal condition. No significant correlations were found between self-reported literary familiarity and eye tracking patterns. Discussion: Despite limitations, this proof-of-concept study provides insights into reading patterns that can help to define objectively the nature of poetic material as requiring slower reading particularly characterised by more and longer fixations and eye movements backwards through the texts compared to the faster, more linear reading of prose. Future research using these, and other psychophysiological metrics can begin to unpack the putative cognitive benefits of reading literary material.

A Systematic Review and Conceptual Framework of Biophilic Design Parameters in Clinical Environments.

OBJECTIVES: To provide a live-experience knowledge base about biophilic design parameters and environmental features to inform policy and design in clinical therapeutic environments. BACKGROUND: It is increasingly important to review hospital design to make the best use of the affordances of natural elements in supporting both patients' and staff's physical and psychological well-being. The biophilic design theory provides an appropriate design approach. However, current biophilic design frameworks fail to provide efficiently standardized guidance. This systematic review aims to examine the experience of hospital users (patients and staff) with a view to informing a standardized biophilic design framework to improve future design in this context. METHODS: This study performed a review and synthesis of nine studies identified using systematic procedures focusing on biophilic design features in healthcare environments. RESULTS: The study identified a selection of biophilic parameters specifically relevant to this building typology, according to three different user groups: outpatients (fresh air, light-daylight, thermal comfort, welcoming and relaxing), inpatients (feeling relaxed and comfortable, prospect refuge, security and protection, light-daylight, view), and staff (privacy-refuge, quietness). CONCLUSIONS: The systematically identified studies helped to identify and rank the biophilic design parameters that appear the most critical for promoting and supporting human health and well-being in clinical therapeutic environments from the user's perspective. It also provides an up-to-date compilation of crucial design interventions related to biophilic parameters and as such provides benchmark information for future research and design guidance in these environments.

Accommodation environments and student mental health in the UK: the role of relational spaces.

BACKGROUND: Despite Universities UK emphasising a "whole university approach" to improve mental health and wellbeing, quantitative research exploring the role of accommodation environments in student mental health is limited. AIM: To explore the effects of physical and social structures on university student mental health in the UK. METHODS: Using a cross-sectional sample of newly acquainted student residents living in shared accommodation in North West England (n = 904), this study sought to investigate how accommodation environments influence students' mental health with a focus on the concept of relational spaces. RESULTS: Within the milieu of university accommodation, a low sense of belonging and feeling uncomfortable were associated with higher levels of depression, anxiety, and loneliness. Poor relationships with fellow residents and not using communal areas were associated with higher levels of depression and loneliness, whilst sharing cooking with others was associated with higher levels of depression and anxiety. CONCLUSIONS: For students to flourish in their new homes, accommodation providers must consider relational wellbeing, making places that foster a sense of belonging where students feel sufficiently connected to others. As empowering communities and promoting community cohesion is central to health and wellbeing promotion, greater efforts need to be made to consider relational aspects of space and wellbeing in the design and stewardship of student accommodation.

Beyond the sentence: Shared reading within a high secure hospital.

Ashworth Hospital provides care for inpatients detained under the Mental Health Acts who present a danger to themselves or others. Rehabilitative interventions can help support the best outcomes for patients, their families, care providers, and society. The efficacy of weekly Shared Reading sessions for four patients with experience of psychosis and a history of self-harm was investigated using a 12-month longitudinal case series design. Session data were subjected to psychological discourse analysis to identify discursive strategies employed to accomplish social action and change over the duration of the intervention. Archetypes of interactional achievement across sessions emerged. Broadening of capacity to consider was demonstrated through increased hedging and less declarative language. Increased assertiveness was achieved through reduced generalisation marked by a transition from second-person plural pronouns to more first-person singular pronouns. Avoidance of expression and disagreement strategies diminished over time. In addition, heightened engagement was accomplished through the increased tendency to employ functionally related and preferred responses within adjacency pairs, which mirrored non-verbal communicative strategies. Shared Reading shows promise for promoting the interactional accomplishment for individuals within high secure settings, who are ready to undertake a recovery-related activity. Pathways of interaction should continue to be explored, with consideration to the current study's strengths and limitations. This study contributes to the understanding of efficacious reading study design and the interactional outcomes of therapeutic reading.

'Space to hide': experiences of remote provision across child and adolescent mental health services (CAMHS).

BACKGROUND: The global COVID-19 pandemic necessitated rapid adoption of remote provision across child and adolescent mental health services (CAMHS). The study aimed to understand young people's, parents'/carers', and professionals' experiences of remote provision across CAMHS in one NHS Trust in the North West of England to inform future recovery practice so that remote sessions can continue where they have been well received but re-thought or replaced where they have not. METHODS: The study sample comprised three groups: (i) young people, (ii) parents/carers, and (iii) clinical staff. Semi-structured interviews and focus groups were used to collect data. Data were analysed using thematic analysis. RESULTS: Three overarching themes were identified: 'Remote therapeutic experiences'; 'Spaces and places of therapy'; and 'Future of CAMHS'. Although remote appointments increased flexibility within the service, the quality of the relational experience was altered, typically for the worse. Clinicians felt less able to examine vital forms of non-verbal communication, which were considered instrumental in assessing and engaging people experiencing difficulties, leaving some questioning their professionalism. Although some young people suggested that remote provision increased comfort levels, others felt their place of comfort and safety was invaded. CONCLUSIONS: Reduced travel time for both clinicians and families may increase capacity, enabling the service to meet the increased demand if clinical effectiveness can be preserved. In considering future models of provision, assessing clinical need, patient and family preference, and access to space and hardware are all critical when deciding which modality to use for the best outcomes for each individual.

Validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100) in patients with schizophrenia / Validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100) em pacientes com esquizofrenia

ABSTRACT Social cognition is an especially relevant domain in schizophrenia due to its association with functional impairment. However, we still do not have studies that have validated instruments with internationally established psychometric qualities for the Brazilian population. Objectives: This study aimed to present psychometric qualities and contribute to the validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100). Methods: A total of 104 stabilized patients living in the community diagnosed with schizophrenia and 89 controls were evaluated. We assess the psychometric properties of Hinting Task and FERT-100 for discriminant construct validity, divergent construct validity, convergent construct validity, concurrent criterion validity, and reliability. Results: There is a statistically significant difference between patients and controls regarding social cognition (Hinting Task: Z=6.85, p<0.001; FERT-100: t=4.88, p<0.001). The main predictors of variation in social cognition were the neurocognitive domains. The associations between social cognition tests and other studied variables are similar to what is found in the literature. Social cognition maintains correlation with functional capacity even when neurocognition is taken into account. Conclusions: The validity of the Brazilian version of Hinting Task and FERT-100 can be determined, since the relationship of these tests with other clinical variables is similar to that observed in the literature.

RESUMO A cognição social é um domínio especialmente relevante na esquizofrenia devido à sua associação com o comprometimento funcional. No entanto, ainda não temos estudos que validaram instrumentos com qualidades psicométricas internacionalmente estabelecidas para a população brasileira. Objetivos: Apresentar as qualidades psicométricas e contribuir para a validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100). Métodos: Foram avaliados 104 pacientes estabilizados residentes na comunidade com diagnóstico de esquizofrenia e 89 controles. Avaliou-se as propriedades psicométricas do Hinting Task e FERT-100 para validade de construto discriminante, validade de construto divergente, validade de construto convergente, validade de critério concorrente e confiabilidade. Resultados: Houve uma diferença estatisticamente significativa entre pacientes e controles quanto à cognição social (Hinting Task: Z=6,85; p<0,001. FERT-100: t=4,88; p<0,001). Os principais preditores da variação na cognição social foram os domínios neurocognitivos. As associações entre os testes de cognição social e outras variáveis estudadas são semelhantes às encontradas na literatura. A cognição social mantém correlação com a capacidade funcional mesmo quando a neurocognição é levada em consideração. Conclusões: A validade da versão brasileira do Hinting Task e do FERT-100 pode ser determinada, pois a relação desses testes com outras variáveis clínicas é semelhante à observada na literatura.

Supporting mental health and wellbeing of university and college students: A systematic review of review-level evidence of interventions.

AIMS: The review of reviews had three aims: (i) to synthesize the available evidence on interventions to improve college and university students' mental health and wellbeing; (ii) to identify the effectiveness of interventions, and (iii) to highlight gaps in the evidence base for future study. METHODS: Electronic database searches were conducted to identify reviews in English from high-income OECD countries published between 1999 and 2020. All review-level empirical studies involving post-secondary students attending colleges of further education or universities that examined interventions to improve general mental health and wellbeing were included. Articles were critically appraised using an amended version of the AMSTAR 2 tool. Evidence from the included reviews were narratively synthesized and organised by intervention types. RESULTS: Twenty-seven reviews met the review of reviews inclusion criteria. The quality of the included reviews varied considerably. Intervention types identified included: mindfulness-based interventions, psychological interventions, psychoeducation interventions, recreation programmes, relaxation interventions, setting-based interventions, and stress management/reduction interventions. There was evidence that mindfulness-based interventions, cognitive behavioural therapy (CBT), and interventions delivered via technology were effective when compared to a passive control. Some evidence suggested that the effects of CBT-related interventions are sustained over time. Psychoeducation interventions do not appear to be as effective as other forms of intervention, with its effects not enduring over time. CONCLUSIONS: The review of reviews located a sizeable body of evidence on specific interventions such as mindfulness and cognitive-behavioural interventions. The evidence suggests that these interventions can effectively reduce common mental health difficulties in the higher education student body. Gaps and limitations in the reviews and the underlying body of evidence have been identified. These include a notable gap in the existing body of review-level evidence on setting-based interventions, acceptance and commitment training, and interventions for students attending colleges in UK settings.

Characteristics of mental health stability during COVID-19: An online survey with people residing in a city region of the North West of England.

BACKGROUND AND AIM: Despite the significant mental health challenges the COVID-19 pandemic and its associated government measures have presented, research has shown that the majority of people have adapted and coped well. The aim of this study was i) to determine the proportion of people with mental stability and volatility during the pandemic in a North West England city region sample and ii) to establish group differences in psychosocial variables. Mental stability and volatility refer to the extent to which individuals reported change in levels of common mental health symptoms over the course of 12 weeks. No change in mental health over the 12 weeks reflected mental stability whilst change in mental health reflected mental volatility. METHOD: A two-wave-online survey (N = 163) was used to explore the psychological and social impact of the pandemic on relatively disadvantaged neighbourhoods within the region. The data collected represents 12 weeks of individual pandemic experience between mid-June and mid-December 2020. A three-level composite common mental health change variable was created combining self-reported anxiety and depression to group stable, volatile, and very volatile individuals in terms of the changeability of their mental health. Kruskal-Wallis with post-hoc tests were used to determine how people with mental stability and volatility differed on factors categorised within an ecological framework of resilience (individual, community, societal, and COVID-19 specific). RESULTS: Individuals categorised as 'stable' in terms of mental health symptoms (63.6%) had better mental and physical health; were more tolerant of uncertainty; and reported higher levels of resilience and wellbeing compared to 'very volatile' people (19.8%). These individuals also reported feeling less socially isolated, experienced a greater sense of belonging to their community which was more likely to fulfil their needs, and were more likely to have access to green space nearby for their recommended daily exercise. 'Stable' individuals did not report worrying any more during the pandemic than usual and tolerated uncertainty better compared to those in the 'volatile' group. IMPLICATIONS: The majority of participants in this sample were mentally stable and coping well with the challenges presented by the pandemic. The resilience of these individuals was related to key place-based factors such as a strong sense of community and useable local assets. The data showcase the role of place-based social determinants in supporting resilience and thereby highlight key preventative measures for public mental health during times of international crisis.

Daily testing of contacts of SARS-CoV-2 infected cases as an alternative to quarantine for key workers in Liverpool: A prospective cohort study.

Background: Covid-19 test-to-release from quarantine policies affect many lives. The SMART Release pilot was the foundation of these policies and an element of the world's largest population cohort study of community-wide, SARS-CoV-2 rapid antigen testing. The objective of the study was to evaluate daily lateral flow testing (LFT) as an alternative to 10-14 days quarantine for key worker contacts of known Covid-19 (or SARS-CoV-2 infection) cases. Methods: Prospective cohort study incorporating quantitative and qualitative research methods to consider how serial LFT compares with PCR testing to detect SARS-CoV-2 infections and to understand experiences/compliance with testing and the viability of this quarantine harm-reduction strategy. Participants were residents of the Liverpool area who were key workers at participating fire, police, NHS and local government organisations in Liverpool, and who were identified as close contacts of cases between December 2020 and August 2021. Thematic qualitative analysis was used to evaluate stakeholder meetings. Findings: Compliance with the daily testing regime was good across the three main organisations in this study with 96·9%, 93·7% and 92·8% compliance for Merseyside Police, Merseyside Fire & Rescue Service and Alder Hey Children's Hospital respectively. Out of 1657 participants, 34 positive Covid-19 cases were identified and 3 undetected by the daily LFT regime. A total of 8291 workdays would have been lost to self-isolation but were prevented due to negative daily tests. Organisations reported that daily contact testing proved useful, flexible and well-tolerated initiative to sustain key worker services. Interpretation: Compliance with daily testing among key workers was high, helping sustain service continuity during periods of very high risk of staffing shortage. Services reported that the pilot was a "lifeline" and its successful delivery in Liverpool has been replicated elsewhere. Funding: This report is independent research commissioned by DHSC and part funded by DHSC and NIHR. Further funding was received from Liverpool City Council, the EPSRC and MRC.

Open spaces and a sense of belonging improve wellbeing.

The studyMcElroy E, Ashton M, Bagnall AM, et al. The individual, place, and wellbeing-a network analysis. BMC Public Health 2021;21:1621.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/open-spaces-and-community-cohesion-improve-wellbeing/.

Challenging Empathic Deficit Models of Autism Through Responses to Serious Literature.

Dominant theoretical models of autism and resultant research enquiries have long centered upon an assumed autism-specific empathy deficit. Associated empirical research has largely relied upon cognitive tests that lack ecological validity and associate empathic skill with heuristic-based judgments from limited snapshots of social information. This artificial separation of thought and feeling fails to replicate the complexity of real-world empathy, and places socially tentative individuals at a relative disadvantage. The present study aimed to qualitatively explore how serious literary fiction, through its ability to simulate real-world empathic response, could therefore enable more ecologically valid insights into the comparative empathic experiences of autistic and non-autistic individuals. Eight autistic and seven non-autistic participants read Of Mice and Men for six days while completing a semi-structured reflective diary. On finishing the book, participants were asked to engage in three creative writing tasks that encouraged reflective thinking across the novel. Thematic and literary analysis of the diary reflections and writing tasks revealed three main themes (1) Distance from the Novel; (2) Mobility of Response; (3) Re-Creating Literature. Findings demonstrated the usefulness of serious literature as a research tool for comparing the empathic experiences of autistic and non-autistic individuals. Specifically, autistic individuals often showed enhanced socio-empathic understandings of the literature with no empathy deficits when compared to non-autistic participants.