Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis.

INTRODUCTION: The relationship between interpersonal trauma and psychosis is well established, and research is now focused on identifying mechanisms that may explain this relationship. Models of trauma and psychosis increasingly emphasize a broad range of affective processes, yet the overall effect of these affective processes is not well understood. AIM: This review systematically examined the effect of any form of long-term affective dysfunction on the relationship between interpersonal trauma and psychosis. Where possible, it used meta-analytic techniques to quantify the overall magnitude of this effect. METHOD: Searches were conducted using PsychINFO, MEDLINE and CINAHL databases, and eligible studies were appraised for methodological quality. Narrative synthesis and meta-analytic methods were used to evaluate evidence. RESULTS: Twenty-nine studies met criteria for inclusion. Five affective mediators were found; depression, anxiety, affective dysregulation, loneliness and attachment. Findings from both the narrative synthesis (n = 29) and meta-analysis (n = 8) indicated that, overall, affect is a small but significant mediator of the relationship between interpersonal trauma and psychosis (pooled Cohen's d = 0.178; pooled 95 % CI: 0.022-0.334). CONCLUSIONS: Overall, findings support affective pathways to psychosis, though highlight the need for further research on broader affective mediators (loneliness, shame). The small effect size found in the meta-analysis also points to the potential importance of non-affective mediators. Clinically, these findings highlight the value of treatment modalities that attend to multiple mechanisms in the relationship between interpersonal trauma and psychosis. Future research should focus on the interplay and causal sequence between these mechanisms to further understand pathways between interpersonal trauma and psychosis.

Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience.

LAY ABSTRACT: Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.

Parents' Information Needs in Relation to Adolescent Self-Harm: Perspectives of Parents and Professionals.

OBJECTIVE: Discovering that an adolescent is self-harming is extremely distressing for parents and this distress can be compounded by lack of easily accessible and well targeted information on what they can do to help. Some research has even suggested that parental distress can be an obstacle to seeking professional help. This paper describes two studies that sought to identify the information needs of parents in the immediacy of discovering self-harm and in ongoing efforts to support their child. METHOD: Study 1: on-line survey of 128 parents who had experienced their child's self-harm; study 2: two-round Delphi method with 29 professionals who provide therapeutic interventions to adolescents who self-harm. The primary aim of both studies was to elicit views on parents' information needs in relation to supporting adolescents who self-harm. RESULTS: There was a high level of agreement between parents and professionals on the needs for information on topics such as: communication, psychoeducation, managing emotional responses, parenting strategies and interventions. The professionals also emphasized the need for parents to practice self-care and the value of teaching alternative coping strategies to adolescents. Parents placed greater emphasis than professionals on the need for information on future therapeutic needs. CONCLUSION: Despite the agreement between parents and professionals on most of the information needed, there were sufficient differences in emphasis to confirm the importance of consulting with both groups. The findings can be used to develop information sources that are specifically tailored to the needs of parents at all stages of adolescent self-harm.

Parents want psychoeducation on self-harm and help managing emotional responsesProfessionals emphasize parent self-care and teaching adolescents other ways to copeParents should be consulted to ensure their information needs are fully understood.

Qualitative analysis of the cognitive triad in a sample of the general population in response to the COVID-19 pandemic.

This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01;  X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations. This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01;  X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations.

Perceived injustice and its impact on psychological distress in cancer patients and survivors.

PURPOSE: Perceived injustice is a novel psychosocial construct that reflects negative cognitive appraisals of unfairness, externalized blame and the irreparability and severity of one's loss. Previous research has highlighted the negative impact of perceived injustice on recovery and mental health outcomes, particularly in pain-related samples. This study aimed to (i) explore the role of perceived injustice on psychological outcomes in a general cancer population and (ii) describe demographic and psychosocial characteristics associated with perceptions of injustice. METHODS: The study employed a cross-sectional, observational design. Using a purposive convenience sampling technique, individuals that have or have had cancer completed an online survey assessing perceived injustice (IEQ), psychological distress (HADS), mental adjustment to cancer (Mini-MAC) and satisfaction with care (PSCC) (N = 121). RESULTS: Levels of perceived injustice were high with 43.2% of the sample scoring in the clinical range. Hierarchical regression analyses showed that perceived injustice contributed unique variance to the prediction of anxiety and depression. Low satisfaction with care, being under the age of 40 and not having children were identified as significant predictors of perceived injustice. Satisfaction with care did not significantly moderate the association between perceived injustice and mental health outcomes but directly impacted anxiety levels. CONCLUSION: Cancer patients reporting high levels of perceived injustice are at greater risk of feeling psychologically distressed. Prevention and management of injustice perceptions may require interventions targeting specific negative attributions, as well as cancer care in general. Further implications for healthcare practice are discussed.

A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression.

The mental health impact of the COVID-19 pandemic has been significant, with many regions across the globe reporting significant increases in anxiety, depression, trauma, and insomnia. This study aims to validate a potential cognitive model of maintenance factors of COVID-19 related distress by examining psychological predictors of distress, and their goodness-of-fit as a coherent model. Participants from the general population (n = 555) were recruited using a cross-sectional on-line survey design, assessing Demographic factors, Anxiety, Depression, Loneliness, COVID-19 related distress, Trauma Cognitions related to COVID-19, Rumination, Safety Behaviours, Personality Factors, and Mental Effort related to COVID-19. A series of stepwise linear regressions found that components of the model were significant and accounted for a large percentage of variance when examining Covid-19 related distress (R2 = 0.447 Covid Stress Scale), Anxiety (R2 = 0.536 DASS-Anxiety Subscale) and Depression (R2 = 0.596 Depression DASS-subscale). In a confirmatory factor analysis, Loneliness, Post-Traumatic Cognitions about Self, Post-Traumatic Cognitions about the World, Emotional Stability, and Mental Effort related to COVID-19 loaded onto a single factor. The final model showed adequate fit (CFI = 0.990, TLI = 0.983, RMSEA = 0.053 (0.027-0.080), GFI = 0.986, SRMR = 0.0216, χ2 = 23.087, p = .006). The results highlight the importance of cognitive factors, such as post-traumatic cognitions, rumination, and mental effort in maintaining COVID-19 related distress.

A meta-analysis of targeted interventions for reducing suicide-related behaviour and ideation in adolescents: Implications for trial design.

INTRODUCTION: Suicidality among young people is a significant societal issue. The current study conducted a meta-analysis of community and clinical interventions targeting suicide attempts, self-harm, and suicidal ideation in adolescents. METHODS: Interventions targeting suicide attempts, self-harm and suicidal ideation were identified by searching PsychINFO, Medline, CINAHL and Embase in line with the PRISMA statement. Study quality was determined using a risk of bias tool. Meta-analyses examined the efficacy of the interventions. Effect sizes were calculated for suicidal ideation data (continuous data) using Hedge's g for standardised mean differences. Suicide attempts and self-harm (dichotomous data) were calculated using odds ratios (ORs). RESULTS: Seventeen RCTs were included in the meta-analysis. No significant differences were found between treatment and control groups on measures of suicide attempts or self-harm. A small effect-size was observed on measures of suicidal ideation (g = 0.47). A secondary meta-analysis investigated change over time in treatment as usual conditions, finding significant large effect-sizes for suicide attempts (OR = 18.67), self-harm (OR = 12.77), and suicidal ideation (g = 0.86). LIMITATIONS: The methodological decision to focus on specific outcomes over a broad definition of self-harm excluded some papers, which have been included in other reviews. It is unlikely to have significantly affected the overall results. The review was not preregistered. CONCLUSIONS: These twin findings highlight the importance overcoming the methodological difficulty of discerning effective interventions during a period of baseline improvement. We suggest that future trials should move away from broadly addressing "suicidality/self-harm" and encourage a greater targeting of at-risk individuals.

The case for change: aviation worker wellbeing during the COVID 19 pandemic, and the need for an integrated health and safety culture.

The workplace is an important setting for health protection, health promotion and disease prevention. Currently, health and wellbeing approaches at an aviation organisational level are not addressing both human and safety needs. This issue has been intensified since the COVID 19 pandemic. This paper reports on the findings of a survey pertaining to aviation worker wellbeing and organisational approaches to managing wellbeing and mental health. The survey was administered at two different time periods during the COVID 19 pandemic (2020 and 2021). Collectively, feedback was obtained from over 3000 aviation workers. Survey feedback indicates that aviation workers are experiencing considerable challenges in relation to their health and wellbeing. These challenges are not being adequately addressed at an organisational level, which creates risk both from an individual and flight safety perspective. The descriptive findings of both surveys along with a regression analysis is used to make a principled case for augmenting the existing approach to managing aviation worker wellbeing (including mental health), at both an organisational and regulatory level. It is argued that aviation organisations, with the support of the regulator should implement a preventative, ethical and evidence-based strategy to managing wellbeing and mental health risk. Critically, aviation organisations need to advance and integrated health, wellbeing, and safety culture. This necessitates an alignment of human, business, and safety objectives, as articulated in concepts of corporate social responsibility (CSR) and responsible work. Critically, this approach depends on trust and the specification of appropriate protections, so that aviation workers feel safe to routinely report wellbeing levels and challenges, and their impact on operational safety.

Evaluating the role of perceived injustice in mental health outcomes in cervical cancer care.

PURPOSE: Perceived injustice is a novel psychosocial construct which reflects negative cognitive appraisals of blame, unfairness, and the severity and irreparability of one's loss. Experiences of injustice are increasingly recognised as a key determinant of recovery outcomes in healthcare. The aim of this study was to explore the impact of perceived injustice on psychological outcomes amongst a group of cancer patients and survivors who received false-negative smear results under a National Cervical Cancer Screening Programme (CervicalCheck). METHODS: Women who received false-negative smear results who were involved in the CervicalCheck controversy in Ireland completed online measures of perceived injustice (IEQ), psychological distress (depression and anxiety as measured by the HADS), and satisfaction with care (PSCC) (n = 144). RESULTS: Rates of psychological distress in this sample were high, with 76% scoring in the clinical range for anxiety, 51% in the clinical range for depression, and 88% in the clinical range for perceived injustice. Hierarchical regression analyses revealed that perceived injustice contributed unique variance to the prediction of depression and anxiety. Satisfaction with care significantly moderated the association between perceived injustice and depression. CONCLUSIONS: Cancer patients who report high levels of perceived injustice are at greater risk for experiencing psychological distress. The relationship between perceived injustice and depression may vary as a function of satisfaction with care. Addressing issues of perceived injustice in the psychosocial and rehabilitative care of cancer patients may support the early identification of those at risk of significant psychological distress and enhance intervention success. Implications for policy and practice in healthcare are discussed.

Emotional dysregulation in adults: The influence of rumination and negative secondary appraisals of emotion.

BACKGROUND: Emotional dysregulation is commonly discussed as a transdiagnostic factor in clinical populations. The present study aims to investigate cognitive factors (rumination and negative appraisals of emotion) in the maintenance of emotional dysregulation in a normative sample in order to partially validate a cognitive model of emotional dysregulation and to examine the potential clinical relevance of addressing cognitive factors in the treatment of emotional dysregulation. METHODS: People who were 18 or older were asked to participate via a university research system and social media. Participants (N = 216) were asked to fill out online surveys regarding emotional dysregulation, rumination and negative secondary appraisals of emotion. RESULTS: People who had higher emotional dysregulation levels displayed a greater tendency to ruminate and were more prone to negative secondary appraisals of emotion. There was a positive association between rumination and negative secondary appraisals of emotion, and this association was mediated by emotional dysregulation. LIMITATIONS: The present study was solely based on self-report measurements and the collected data were cross-sectional. CONCLUSIONS: The present study showed that a wide spectrum of experiences of emotional dysregulation occurred in a normative sample. The significant mediation highlighted the maintaining role of rumination and negative appraisals in emotional dysregulation. These data highlight the importance of addressing cognitive factors in emotional dysregulation.

A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression.

Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened pain, disability, medication use, anger and post-traumatic stress. The aim of this paper was to systematically review and critically appraise the association between perceived injustice and depressive symptomatology across a wide range of medical and mental health populations, including acute and chronic pain samples. A search of published, English language studies in the PubMed, EMBASE, CINAHL, and PsycINFO databases from 1990 to June 2020 was performed. Thirty-three studies met inclusion criteria with a total sample of 5,425 individuals (61% female), primarily with acute injury or chronic pain. Results indicated a moderate to strong positive association between perceived injustice and depressive symptomatology (meta-analysis pooled effect of r = .57, 95% confidence interval [.55, .58], P< .001). A narrative synthesis of regression models indicated standardized beta coefficients between .19 and .66, with perceived injustice consistently contributing significant unique variance to the prediction of depression in final regression equations. Selection bias and response bias were common limitations in the studies. The clinical implications of an association between injustice and depression in acute and chronic pain are discussed. PROSPERO: CRD42019143465. PERSPECTIVE: This review demonstrates that in acute injury and chronic pain samples, perceived injustice is associated with depression. These findings could help clinicians in the field of pain and rehabilitation identify who may be at greater risk for a problematic recovery trajectory.

Predicting uptake of group CBT in a first-episode psychosis cohort.

Many people with psychosis do not engage in psychological treatments when offered. We examined variables that predicted uptake of group cognitive behavioural therapy (CBT) in first-episode psychosis. We assessed all consenting consecutive referrals over a 2-year period. T-tests and logistic regressions examined factors which predicted uptake. The suitability for short-term CBT scale (SSCT) and negative symptoms successfully differentiated engagement and non-engagement. A model combining negative symptoms and the SSCT significantly predicted uptake of group CBT. Attention has not been paid to poor uptake of psychological treatments in psychosis. This may have a greater impact on outcomes than treatment effectiveness.

Appraisals and responses to experimental symptom analogues in clinical and nonclinical individuals with psychotic experiences.

OBJECTIVE: Cognitive models of psychosis suggest that anomalous experiences alone do not always lead to clinical psychosis, with appraisals and responses to experiences being central to understanding the transition to "need for care". METHODS: The appraisals and response styles of Clinical (C; n = 28) and Nonclinical (NC; n = 34) individuals with psychotic experiences were compared following experimental analogues of thought interference (Cards Task) and auditory hallucinations (Virtual Acoustic Space Paradigm). RESULTS: The groups were matched in terms of their psychotic experiences. As predicted, the C group scored higher than the NC group on maladaptive appraisals following both tasks, rated the experience as more personally significant, and was more likely to incorporate the experimental setup into their ongoing experiences. The C group also appraised the Cards Task as more salient, distressing, and threatening; this group scored higher on maladaptive-and lower on adaptive-response styles, than the NC group on both tasks. CONCLUSIONS: The findings are consistent with cognitive models of psychosis, with maladaptive appraisals and response styles characterizing the C group only. Clinical applications of both tasks are suggested to facilitate the identification and modification of maladaptive appraisals.

Self-referrers to community workshops: who are they and why do some participants not consult with their GP about their mental health difficulties?

BACKGROUND: Self-referring is an important pathway to care that is being used increasingly by services, but little research has been conducted in this area. AIMS: To examine whether self-referrers would (i) be representative of the local community; (ii) be significantly psychologically distressed; (iii) be demographically similar to GP consulters and (iv) to investigate non-consulters' attitudinal reasons for not consulting their GPs. METHOD: The study is a cross-sectional analysis of 442 self-referrers who attended one of six one-day Cognitive Behavioural Therapy workshop programmes in the community. Socio-demographic details and information about past contact with GP services and attitudes towards non-consulting were collected. Parametric and non-parametric tests and logistic regressions were used to analyse the data. RESULTS: Self-referrers were representative of the local population although a disproportionate number of participants were unemployed and unoccupied. Over a quarter (26.5%) had not consulted their GPs. GP consulters had significantly higher clinical outcome in routine evaluation scores, though the scores of both groups were in the clinical range. Non-consulters tended to be from black, minority and ethnic groups and male. Attitudinal reasons for not consulting their GP were independently categorised as Perception of Services, Perception of Illness and Self-coping. CONCLUSIONS: Self-referral offers access to services to people who have been previously reluctant to consult.

The role of safety-seeking behaviours in maintaining threat appraisals in psychosis.

AIM: This study investigated the interaction between appraisals and safety behaviours in the maintenance of psychotic symptoms. METHOD: The study recruited a population who had persistent psychotic experiences but who had no 'need-for-care' (Persistence group; n = 39) as well as a population who had a diagnosed psychotic disorder and were receiving current treatment (Impairment group; n = 28). The participants were assessed on semi-structured interviews of appraisals and safety behaviours and on anxiety and depression questionnaires. RESULTS: The two groups did not differ in total or first rank psychotic experiences, but the Persistence group showed less anomaly-related distress, depression and anxiety than the Impairment group. As predicted, the Impairment group displayed more threat appraisals and safety behaviours than the Persistence group, with a greater frequency of safety behaviours being related to higher levels of threat appraisals and anomaly-related distress. Threat appraisals mediated the relationship between safety behaviours and anomaly-related distress, suggesting that threat appraisals may maintain distress, a defining feature of Impairment status. CONCLUSIONS: These data provide support for the cognitive model of psychosis in suggesting that cognitive and behavioural factors are key in differentiating non-clinical anomalous experiences from clinical psychotic status. These data suggest that therapy should target threat appraisals and safety-seeking behaviours in order to decrease distress.

Group cognitive behavioural therapy as a treatment for negative symptoms in first-episode psychosis.

AIM: We aimed to test the idea that there is an early critical time period during a psychotic illness when patients may be more responsive to psychological treatment attention. METHODS: We tested this hypothesis by comparing the treatment responsiveness to group cognitive behavioural therapy (CBT) of 25 first-episode psychosis participants (FEP) and 15 patients with currently stable psychosis (n = 40). RESULTS: Following 12 sessions of outpatient-based group CBT, there were significant decreases in positive, depressive and anxiety symptoms, and an improvement in quality of life for both groups. However, negative symptoms only improved in the FEP group. CONCLUSION: Considering the pernicious nature of negative symptoms as well as the difficulties in treating them, this study provides some support for the concept of early intervention with CBT.

Cognitive deterioration and duration of untreated psychosis.

AIM: To examine the relationship between cognitive deterioration and the duration of untreated psychosis (DUP) in a first-episode psychosis sample. METHOD: We assessed a consecutive sample of first-episode psychosis participants (N = 50) with measures of cognitive deterioration and DUP. RESULTS: Using correlations and stepwise linear regressions, we found strong relationships between DUP and measures of cognitive deterioration. CONCLUSIONS: The length of DUP predicted cognitive deterioration. These results highlight a potential DUP grace period (>6 months) in which significant cognitive deterioration may be averted.

Is the duration of untreated psychosis temporally stable?

Although there is some evidence that duration of untreated psychosis (DUP) is geographically stable, few have examined whether the phenomenon is temporally stable. We examined DUP in two cohorts within two discrete time periods (1995-1999 and 2003-2005) spanning a decade in the same geographically defined community psychiatric service with no early intervention programme. Patients were diagnosed by Structured Clinical Interview for DSM (SCID) and we determined the DUP using the Beiser Scale. The DUP of the 240 participants did not differ significantly between study periods.

Toxic psychosis? Duration of untreated psychosis, symptomatology and cognitive deterioration in first episode psychosis.

OBJECTIVES: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample. METHOD: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology. RESULTS: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors. CONCLUSIONS: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.