Effectiveness of providing university students with a mindfulness-based intervention to increase resilience to stress: 1-year follow-up of a pragmatic randomised controlled trial.

BACKGROUND: There is concern that increasing demand for student mental health services reflects deteriorating student well-being. We designed a pragmatic, parallel, single-blinded randomised controlled trial hypothesising that providing mindfulness courses to university students would promote their resilience to stress up to a year later. Here we present 1-year follow-up outcomes. METHODS: University of Cambridge students without severe mental illness or crisis were randomised (1:1, remote software-generated random numbers), to join an 8-week mindfulness course adapted for university students (Mindfulness Skills for Students (MSS)), or to mental health support as usual (SAU). RESULTS: We randomised 616 students; 53% completed the 1-year follow-up questionnaire. Self-reported psychological distress and mental well-being improved in the MSS arm for up to 1 year compared to SAU (p<0.001). Effects were smaller than during the examination period. No significant differences between arms were detected in the use of University Counselling Service and other support resources, but there was a trend for MSS participants having milder needs. There were no differences in students' workload management; MSS participants made more donations. Home practice had positive dose-response effects; few participants meditated. No adverse effects related to self-harm, suicidality or harm to others were detected. CONCLUSION: Loss to follow-up is a limitation, but evidence suggests beneficial effects on students' average psychological distress that last for at least a year. Effects are on average larger at stressful times, consistent with the hypothesis that this type of mindfulness training increases resilience to stress. TRIAL REGISTRATION NUMBER: ACTRN12615001160527.

PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare.

Reducing physical intervention in mental health inpatient care is a global priority. It is extremely distressing both to patients and staff. PROactive Management of Integrated Services and Environments (PROMISE) was developed within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to bring about culture change to decrease coercion in care. This study evaluates the changes in physical intervention numbers and patient experience metrics and proposes an easy-to-adopt and adapt governance framework for complex interventions. PROMISE was based on three core values of: providing a caring response to all distress; courage to challenge the status quo; and coproduction of novel solutions. It sought to transform daily front-line interactions related to risk-based restrictive practice that often leads to physical interventions. PROactive Governance of Recovery Settings and Services, a five-step governance framework (Report, Reflect, Review, Rethink and Refresh), was developed in an iterative and organic fashion to oversee the improvement journey and effectively translate information into knowledge, learning and actions. Overall physical interventions reduced from 328 to 241and210 across consecutive years (2014, 2015-2016 and 2016-2017, respectively). Indeed, the 2016-2017 total would have been further reduced to 126 were it not for the perceived substantial care needs of one patient. Prone restraints reduced from 82 to 32 (2015-2016 and 2016-2017, respectively). During 2016-2017, each ward had a continuous 3-month period of no restraints and 4 months without prone restrains. Patient experience surveys (n=4591) for 2014-2017 rated overall satisfaction with care at 87%. CPFT reported fewer physical interventions and maintained high patient experience scores when using a five-pronged governance approach. It has a summative function to define where a team or an organisation is relative to goals and is formative in setting up the next steps relating to action, learning and future planning.

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities.

The effects of sexual violence on psychosocial outcomes in formerly abducted girls in Northern Uganda: the WAYS study.

BACKGROUND: The objective of this study is to investigate the effects of sexual violence on the odds of different psychosocial outcomes (depression, psychotic symptoms, somatic complaints, conduct problems, daily functioning, community relations, and stigma) among formerly abducted girls in Uganda. METHODS: Data from an on-going War-Affected Youth Study (WAYS) in Uganda was used to compute the prevalence of psychosocial problems (scores ≥ 75th percentile) among three categories of formerly abducted girls (1) no history of sexual violence without children, 2) a history of sexual violence without children, and 3) a history of sexual violence with children as a consequence) among 210 women (age 22.06, SD = 2.06, range 18-25). Multiple logistic regression analyses were used to examine differences in psychosocial outcomes by the different categories of formerly abducted girls. RESULTS: Compared to participants with no history of sexual violence and without any children, the odds of adverse psychosocial outcomes were increasingly higher for all psychosocial dimensions for those who reported sexual violence with or without children. Those with a history of sexual violence and with children as a consequence had more than five times the odds of reporting depressive symptoms (OR, 5.37; 95% CI (1.45-19.90), somatic complaints (OR, 6.59; 95% CI (1.80 - 24.11), and stigma (OR, 13.85; 95% CI (3.73 - 51.42) compared to those who did not report sexual violence. CONCLUSION: This study highlighted the risks of psychosocial problems among different categories of formerly abducted girls regarding sexual violence. Vulnerability to psychosocial problems among formerly abducted girls is further compounded by sexual violence, child care, stigma, and poverty.