The online world as a means of connection and disconnection during the COVID-19 pandemic: A test of the interpersonal-connections-behaviour framework.

BACKGROUND: The interpersonal-connections-behaviour framework proposes that social media is helpful/unhelpful to the individual to the extent that it facilitates/hinders satisfaction of core needs for acceptance and belonging (connecting and disconnecting pathways). However, little research has, to date, explicitly tested this framework. METHODS: Both pathways were explored in a cross-sectional sample of UK adults at the start of the pandemic (N = 632) and in longitudinal (cross-lagged) analyses (N = 227-240). Participants completed measures of online and offline socialising with friends and family (connecting pathway), and online and offline social comparisons (disconnecting pathway), anxiety, depression and loneliness. RESULTS: In cross-sectional analyses higher levels of online comparisons were associated with poorer mental health, an effect that survived after controlling for offline comparisons, and was partially mediated by loneliness. Counter to our predictions, online socialising was also associated with poorer mental health. Longitudinal analyses did not support predicted directions of causality. LIMITATIONS: Limitations include a lack of testing of individual-level moderators, the use of single item questions to probe some constructs, and an inability to test for effects potentially operating at different time-scales. CONCLUSIONS: The findings reported partially support the interpersonal-connections-behaviour framework in highlighting a disconnecting (but not connecting) pathway between online engagement and mental health. From a clinical perspective they highlight the importance of including people's online lives when considering mental health risk and resilience, particularly (one might argue) during periods of social isolation.

Post-migration living difficulties and poor mental health associated with increased interpretation bias for threat.

Previous research has found associations between mental health difficulties and interpretation biases, including heightened interpretation of threat from neutral or ambiguous stimuli. Building on this research, we explored associations between interpretation biases (positive and negative) and three constructs that have been linked to migrant experience: mental health symptoms (Global Severity Index [GSI]), Post-Migration Living Difficulties (PMLD), and Perceived Ethnic Discrimination Questionnaire (PEDQ). Two hundred thirty students who identified as first- (n = 94) or second-generation ethnic minority migrants (n = 68), and first-generation White migrants (n = 68) completed measures of GSI, PEDQ, and PMLD. They also performed an interpretation bias task using Point Light Walkers (PLW), dynamic stimuli with reduced visual input that are easily perceived as humans performing an action. Five categories of PLW were used: four that clearly depicted human forms undertaking positive, neutral, negative, or ambiguous actions, and a fifth that involved scrambled animations with no clear action or form. Participants were asked to imagine their interaction with the stimuli and rate their friendliness (positive interpretation bias) and aggressiveness (interpretation bias for threat). We found that the three groups differed on PEDQ and PMLD, with no significant differences in GSI, and the three measured were positively correlated. Poorer mental health and increased PMLD were associated with a heightened interpretation for threat of scrambled animations only. These findings have implications for understanding of the role of threat biases in mental health and the migrant experience.

Wellbeing while waiting evaluating social prescribing in CAMHS: study protocol for a hybrid type II implementation-effectiveness study.

BACKGROUND: Social prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve mental health and wellbeing in adult populations. In the last few years, it has been used in child and youth settings with promising results. Currently, pathways are being developed for social prescribing in Child and Adolescent Mental Health Services (CAMHS) to support children and young people on treatment waiting lists. The Wellbeing While Waiting study will evaluate whether social prescribing benefits the mental health and wellbeing of children and young people. METHODS: This study utilises an observational, hybrid type II implementation-effectiveness design. Up to ten CAMHS who are developing social prescribing pathways as part of a programme run across England with support from the Social Prescribing Youth Network will participate. Outcomes for children and young people receiving social prescribing whilst on CAMHS waiting lists will be compared to a control group recruited prior to the pathway roll-out. Questionnaire data will be collected at baseline, 3 months and 6 months. Primary outcomes for children and young people are mental health symptoms (including anxiety, depression, stress, emotional and behavioural difficulties). Secondary outcomes include: loneliness, resilience, happiness, whether life is worthwhile, life satisfaction, and service use. An implementation strand using questionnaires and interviews will explore the acceptability, feasibility, and suitability of the pathway, potential mechanisms of action and their moderating effects on the outcomes of interest, as well as the perceived impact of social prescribing. Questionnaire data will be analysed mainly using difference-in-differences or controlled interrupted time series analysis. Interview data will be analysed using reflexive thematic analysis. DISCUSSION: The Wellbeing While Waiting study will provide the first rigorous evidence of the impact of social prescribing for children and young people on waiting lists for mental health treatment. Findings will help inform the prioritisation, commissioning, and running of social prescribing in other CAMHS. To maximise impact, findings will be available on the study website ( https://sbbresearch.org ) and disseminated via national and international networks. TRIAL REGISTRATION: N/A.

The association between sociodemographic inequalities, COVID-related impacts and mental health.

PURPOSE: There are concerns that the social, economic and health impacts of COVID-19 are unevenly distributed, exacerbating existing inequalities. Here we tested the hypotheses that: (H1) the magnitude of these impacts would be associated with symptoms of depression and anxiety early in the pandemic, and (H2) that these impacts would be associated with a range of sociodemographic risk factors. METHODS: Cross-sectional self-report data were collected from a UK sample (N = 632) between the 16th of May and 21st of July 2020, coinciding with the early stages of the pandemic and first UK lockdown. Data were collected on COVID-19 related impacts including financial and social stressors, symptoms of anxiety and depression, and sociodemographic/economic risk factors operationalised at multiple levels including the individual, familial, household and neighbourhood. RESULTS: Using regression analyses both financial and social impacts were independently associated with anxiety (R2 = 0.23) and depression scores (R2 = 0.24), as well as clinically significant generalised anxiety (R2 = 0.14) and depression (R2 = 0.11). In addition, many sociodemographic factors were associated with elevated levels of COVID-19 related impacts, including being younger, female, having lower educational attainment and lower income. LIMITATIONS: The main limitations of the study were its modest sample size, cross sectional design (which precluded inferences about directions of causality), and the relatively high socioeconomic status of the sample (which limited generalisability). CONCLUSIONS: These findings are consistent with a growing body of evidence that suggests that the pandemic has exacerbated existing inequalities, and further, point to particular groups that should be supported by post-COVID-19 recovery policies and initiatives.

Socioeconomic and sex inequalities in parent-reported adolescent mental ill-health: time trends in four British birth cohorts.

BACKGROUND: Studies using symptom-based screeners have suggested that mental ill-health has increased in adolescents in recent decades, however, few studies have tested the equivalence of their instruments, which is critical for inferring changes in prevalence. In addition, little research has explored whether socioeconomic position (SEP) and sex inequalities in adolescent mental health have changed over time. METHODS: Using structural equation modelling, we explored SEP and sex differences in harmonised parent reports of emotional and behavioural problems, using data from four UK birth cohorts: the 1958 National Child Development Study (NCDS'58; n = 10,868), the 1970 British Cohort Study (BCS'70; n = 8,242), the 1991-92 Avon Longitudinal Study of Parents and Children (ALSPAC'91; n = 5,389), and the 2000-01 Millennium Cohort Study (MCS'01; n = 9,338). RESULTS: Compared with the two earliest cohorts, members of MCS'01 had higher latent mean scores on emotional problems (both sexes), and lower scores on behavioural problems (females only). The associations between four indicators of SEP and emotional problems were strongest in MCS'01, with housing tenure having the strongest association. All four SEP indicators were associated with behavioural problems in each cohort, with housing tenure again more strongly associated with problems in the MCS'01. Mediation analyses suggested that the increase in emotional problems occurred despite broadly improving socioeconomic conditions. CONCLUSIONS: Our findings suggest that parent reports of adolescent emotional problems, but not behavioural problems, have risen in recent generations and this trend is not solely due to reporting styles. A failure to address widening social inequalities may result in further increases in mental ill-health amongst disadvantaged young people.

Emotion recognition bias depends on stimulus morphing strategy.

Emotion recognition is vital for social interactions, and atypical (or biased) emotion recognition has been linked to mental health disorders including depression and anxiety. However, biases in emotion recognition vary across studies, and it is unclear whether this reflects genuine group differences in psychological processes underlying emotion recognition or differences in methodologies. One common method to measure biases in emotion recognition involves morphing a face between two emotional expressions in different ratios and asking participants to categorise the faces as belonging to one of the two emotion categories ('direct-morphing' method). However, this method creates morphed faces that are not ecologically valid. Alternatively, faces may be morphed through a neutral expression ('morphing-through-neutral' method), which is more ecologically valid since emotional expressions usually start from a neutral face. To compare these two approaches, we measured emotion recognition biases using two morphing techniques in 136 participants who also completed measures of anxiety (GAD-7) and depression (PHQ-9). Biases obtained using the two methods differed significantly: In the direct-morphing method, participants perceived the central 50% happy/50% angry face as slightly happy, whereas in the morphing-through-neutral method the neutral face was seen as angry. There were no associations between biases and depression or anxiety scores for either morphing method. This study is the first to directly compare emotion recognition biases obtained using two different morphing methods and is a first step towards reconciling discrepancies in the literature.

Integration of visual motion and orientation signals in dyslexic children: an equivalent noise approach.

Dyslexic individuals have been reported to have reduced global motion sensitivity, which could be attributed to various causes including atypical magnocellular or dorsal stream function, impaired spatial integration, increased internal noise and/or reduced external noise exclusion. Here, we applied an equivalent noise experimental paradigm alongside a traditional motion-coherence task to determine what limits global motion processing in dyslexia. We also presented static analogues of the motion tasks (orientation tasks) to investigate whether perceptual differences in dyslexia were restricted to motion processing. We compared the performance of 48 dyslexic and 48 typically developing children aged 8 to 14 years in these tasks and used equivalent noise modelling to estimate levels of internal noise (the precision associated with estimating each element's direction/orientation) and sampling (the effective number of samples integrated to judge the overall direction/orientation). While group differences were subtle, dyslexic children had significantly higher internal noise estimates for motion discrimination, and higher orientation-coherence thresholds, than typical children. Thus, while perceptual differences in dyslexia do not appear to be restricted to motion tasks, motion and orientation processing seem to be affected differently. The pattern of results also differs from that previously reported in autistic children, suggesting perceptual processing differences are condition-specific.

The association between income inequality and adult mental health at the subnational level-a systematic review.

PURPOSE: A systematic review was undertaken to determine whether research supports: (i) an association between income inequality and adult mental health when measured at the subnational level, and if so, (ii) in a way that supports the Income Inequality Hypothesis (i.e. between higher inequality and poorer mental health) or the Mixed Neighbourhood Hypothesis (higher inequality and better mental health). METHODS: Systematic searches of PsycINFO, Medline and Web of Science databases were undertaken from database inception to September 2020. Included studies appeared in English-language, peer-reviewed journals and incorporated measure/s of objective income inequality and adult mental illness. Papers were excluded if they focused on highly specialised population samples. Study quality was assessed using a custom-developed tool and data synthesised using the vote-count method. RESULTS: Forty-two studies met criteria for inclusion representing nearly eight million participants and more than 110,000 geographical units. Of these, 54.76% supported the Income Inequality Hypothesis and 11.9% supported the Mixed Neighbourhood Hypothesis. This held for highest quality studies and after controlling for absolute deprivation. The results were consistent across mental health conditions, size of geographical units, and held for low/middle and high income countries. CONCLUSIONS: A number of limitations in the literature were identified, including a lack of appropriate (multi-level) analyses and modelling of relevant confounders (deprivation) in many studies. Nonetheless, the findings suggest that area-level income inequality is associated with poorer mental health, and provides support for the introduction of social, economic and public health policies that ameliorate the deleterious effects of income inequality. CLINICAL REGISTRATION NUMBER: PROSPERO 2020 CRD42020181507.

A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study.

AIM: This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. METHODS: A mental health "booth" was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. RESULTS: One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). CONCLUSIONS: A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions.

Are socioenvironmental factors associated with psychotic symptoms in people with first-episode psychosis? A cross-sectional study of a West London clinical sample.

OBJECTIVES: To determine whether neighbourhood-level socioenvironmental factors including deprivation and inequality predict variance in psychotic symptoms after controlling for individual-level demographics. DESIGN: A cross-sectional design was employed. SETTING: Data were originally collected from secondary care services within the UK boroughs of Ealing, Hammersmith and Fulham, Wandsworth, Kingston, Richmond, Merton, Sutton and Hounslow as part of the West London First-Episode Psychosis study. PARTICIPANTS: Complete case analyses were undertaken on 319 participants who met the following inclusion criteria: aged 16 years or over, resident in the study's catchment area, experiencing a first psychotic episode, with fewer than 12 weeks' exposure to antipsychotic medication and sufficient command of English to facilitate assessment. OUTCOME MEASURES: Symptom dimension scores, derived from principal component analyses of the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms, were regressed on neighbourhood-level predictors, including population density, income deprivation, income inequality, social fragmentation, social cohesion, ethnic density and ethnic fragmentation, using multilevel regression. While age, gender and socioeconomic status were included as individual-level covariates, data on participant ethnicity were not available. RESULTS: Higher income inequality was associated with lower negative symptom scores (coefficient=-1.66, 95% CI -2.86 to -0.46, p<0.01) and higher levels of ethnic segregation were associated with lower positive symptom scores (coefficient=-2.32, 95% CI -4.17 to -0.48, p=0.01) after adjustment for covariates. CONCLUSIONS: These findings provide further evidence that particular characteristics of the environment may be linked to specific symptom clusters in psychosis. Longitudinal studies are required to begin to tease apart the underlying mechanisms involved as well as the causal direction of such associations.

Corrigendum: Visual surround suppression in schizophrenia.

[This corrects the article DOI: 10.3389/fpsyg.2013.00088.].

Correction: Local and Global Limits on Visual Processing in Schizophrenia.

[This corrects the article DOI: 10.1371/journal.pone.0117951.].

Correction: Reduced Crowding and Poor Contour Detection in Schizophrenia Are Consistent with Weak Surround Inhibition.

[This corrects the article DOI: 10.1371/journal.pone.0060951.].

The component structure of the scales for the assessment of positive and negative symptoms in first-episode psychosis and its dependence on variations in analytic methods.

A secondary analysis was undertaken on Scales for the Assessment of Positive and Negative Symptoms (SAPS/SANS) data from 345 first-episode psychosis (FEP) patients gathered in the West London FEP study. The purpose of this study was to determine: (i) the component structure of these measures in FEP (primary analyses), and (ii) the dependence of any findings in these primary analyses on variations in analytic methods. Symptom ratings were exposed to data reduction methods and the effects of the following manipulations ascertained: (i) level of analysis (individual symptom vs. global symptom severity ratings), (ii) extraction method (principal component vs. exploratory factor analysis) and (iii) retention method (scree test vs. Kaiser criterion). Whilst global ratings level analysis rendered the classic triad of psychotic syndromes (positive, negative and disorganisation), symptom level analyses revealed a hierarchical structure, with 11 first-order components subsumed by three second-order components, which also mapped on to this syndrome triad. These results were robust across data reduction but not component retention methods, suggesting that discrepancies in the literature regarding the component structure of the SAPS/SANS partly reflect the level of analysis and component retention method used. Further, they support a hierarchical symptom model, the implications of which are discussed.

Visual Population Receptive Fields in People with Schizophrenia Have Reduced Inhibitory Surrounds.

People with schizophrenia (SZ) experience abnormal visual perception on a range of visual tasks, which have been linked to abnormal synaptic transmission and an imbalance between cortical excitation and inhibition. However, differences in the underlying architecture of visual cortex neurons, which might explain these visual anomalies, have yet to be reported in vivo Here, we probed the neural basis of these deficits using fMRI and population receptive field (pRF) mapping to infer properties of visually responsive neurons in people with SZ. We employed a difference-of-Gaussian model to capture the center-surround configuration of the pRF, providing critical information about the spatial scale of the pRFs inhibitory surround. Our analysis reveals that SZ is associated with reduced pRF size in early retinotopic visual cortex, as well as a reduction in size and depth of the inhibitory surround in V1, V2, and V4. We consider how reduced inhibition might explain the diverse range of visual deficits reported in SZ.SIGNIFICANCE STATEMENT People with schizophrenia (SZ) experience abnormal perception on a range of visual tasks, which has been linked to abnormal synaptic transmission and an imbalance between cortical excitation/inhibition. However, associated differences in the functional architecture of visual cortex neurons have yet to be reported in vivo We used fMRI and population receptive field (pRF) mapping to demonstrate that the fine-grained functional architecture of visual cortex in people with SZ differs from unaffected controls. SZ is associated with reduced pRF size in early retinotopic visual cortex largely due to reduced inhibitory surrounds. An imbalance between cortical excitation and inhibition could drive such a change in the center-surround pRF configuration and ultimately explain the range of visual deficits experienced in SZ.

Enhanced integration of motion information in children with autism.

To judge the overall direction of a shoal of fish or a crowd of people, observers must integrate motion signals across space and time. The limits on our ability to pool motion have largely been established using the motion coherence paradigm, in which observers report the direction of coherently moving dots amid randomly moving noise dots. Poor performance by autistic individuals on this task has widely been interpreted as evidence of disrupted integrative processes. Critically, however, motion coherence thresholds are not necessarily limited only by pooling. They could also be limited by imprecision in estimating the direction of individual elements or by difficulties segregating signal from noise. Here, 33 children with autism 6-13 years of age and 33 age- and ability-matched typical children performed a more robust task reporting mean dot direction both in the presence and the absence of directional variability alongside a standard motion coherence task. Children with autism were just as sensitive to directional differences as typical children when all elements moved in the same direction (no variability). However, remarkably, children with autism were more sensitive to the average direction in the presence of directional variability, providing the first evidence of enhanced motion integration in autism. Despite this improved averaging ability, children with autism performed comparably to typical children in the motion coherence task, suggesting that their motion coherence thresholds may be limited by reduced segregation of signal from noise. Although potentially advantageous under some conditions, increased integration may lead to feelings of "sensory overload" in children with autism.

Local and global limits on visual processing in schizophrenia.

Schizophrenia has been linked to impaired performance on a range of visual processing tasks (e.g. detection of coherent motion and contour detection). It has been proposed that this is due to a general inability to integrate visual information at a global level. To test this theory, we assessed the performance of people with schizophrenia on a battery of tasks designed to probe voluntary averaging in different visual domains. Twenty-three outpatients with schizophrenia (mean age: 40±8 years; 3 female) and 20 age-matched control participants (mean age 39±9 years; 3 female) performed a motion coherence task and three equivalent noise (averaging) tasks, the latter allowing independent quantification of local and global limits on visual processing of motion, orientation and size. All performance measures were indistinguishable between the two groups (ps>0.05, one-way ANCOVAs), with one exception: participants with schizophrenia pooled fewer estimates of local orientation than controls when estimating average orientation (p = 0.01, one-way ANCOVA). These data do not support the notion of a generalised visual integration deficit in schizophrenia. Instead, they suggest that distinct visual dimensions are differentially affected in schizophrenia, with a specific impairment in the integration of visual orientation information.

Averaging, not internal noise, limits the development of coherent motion processing.

The development of motion processing is a critical part of visual development, allowing children to interact with moving objects and navigate within a dynamic environment. However, global motion processing, which requires pooling motion information across space, develops late, reaching adult-like levels only by mid-to-late childhood. The reasons underlying this protracted development are not yet fully understood. In this study, we sought to determine whether the development of motion coherence sensitivity is limited by internal noise (i.e., imprecision in estimating the directions of individual elements) and/or global pooling across local estimates. To this end, we presented equivalent noise direction discrimination tasks and motion coherence tasks at both slow (1.5°/s) and fast (6°/s) speeds to children aged 5, 7, 9 and 11 years, and adults. We show that, as children get older, their levels of internal noise reduce, and they are able to average across more local motion estimates. Regression analyses indicated, however, that age-related improvements in coherent motion perception are driven solely by improvements in averaging and not by reductions in internal noise. Our results suggest that the development of coherent motion sensitivity is primarily limited by developmental changes within brain regions involved in integrating motion signals (e.g., MT/V5).

An inability to exclude visual noise in migraine.

PURPOSE: People with migraine are relatively poor at judging the direction of motion of coherently moving signal dots when interspersed with noise dots drifting in random directions, a task known as motion coherence. Although this has been taken as evidence of impoverished global pooling of motion signals, it could also arise from unreliable coding of local direction (of each dot), or an inability to segment signal from noise (noise-exclusion). The aim of this study was to determine how these putative limits contribute to impoverished motion processing in migraine. METHODS: Twenty-two participants with migraine (mean age, 34.7 ± 8.3 years; 16 female) and 22 age- and sex-matched controls (mean age, 34.4 ± 6.2 years) performed a motion-coherence task and a motion-equivalent noise task, the latter quantifying local and global limits on motion processing. In addition, participants were tested on analogous equivalent noise paradigms involving judgments of orientation and size, so that the specificity of any findings (to visual dimension) could be ascertained. RESULTS: Participants with migraine exhibited higher motion-coherence thresholds than controls (P = 0.01, independent t-test). However, this difference could not be attributed to deficits in either local or global processing since they performed normally on all equivalent noise tasks (P > 0.05, multivariate ANOVA). CONCLUSIONS: These findings indicate that motion perception in the participants with migraine was limited by an inability to exclude visual noise. We suggest that this is a defining characteristic of visual dysfunction in migraine, a theory that has the potential to integrate a wide range of findings in the literature.