Implicit Sexual Cognitions in Women with Ambiphilic Sexual Attractions: A Comparison to Androphilic and Gynephilic Women.

Previous research using indirect cognitive measures (sometimes referred to as implicit measures) of sexual attraction have shown that women who are attracted to men (androphilic women) show category non-specific responses, whereas those who are attracted to women (gynephilic) show a category-specific bias to women. The purpose of the present study was to examine whether women who explicitly report approximately equal attraction to men and women (ambiphilic) would show similar non-category specific attraction at this implicit level or whether their responses would be more similar to those of gynephilic women. An implicit association task and a priming task were given to 169 women alongside measures of their self-labelled sexual orientation and an explicit measure of their sexual attraction to men and women. The results replicated previous findings of little bias towards either gender in androphilic women and of a strong bias towards females in gynephilic women. The ambiphilic women also showed a strong bias towards females. The findings clearly show that early automatic associations to sex are biased towards females in ambiphilic women and are not consistent with their explicit statements of preference.

Reducing sickness absence and stigma due to mental health difficulties: a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail).

BACKGROUND: Common mental disorders are the leading cause of workplace absences. The Prevail intervention programme aims to reduce stigma and to educate staff and managers about evidence-based low intensity psychological interventions for common mental disorders (depression, anxiety, stress, and distress). Prevail is innovative in taking a public health approach. It is designed to be given to all employees irrespective of their past or current mental health. Prevail was evaluated in three studies examining: (1) the acceptability of the intervention and perceived usefulness; (2) whether the intervention altered stigmatic attitudes and motivation to seek help; and (3) whether the intervention reduced sickness absence, both overall and due to mental health problems. METHODS: A two-armed cluster randomised control trial (RCT) evaluated the effectiveness of Prevail. Employees (N = 1051) at a large UK government institution were randomised to an active intervention or control arm in teams identified by their managers (n = 67). Employees in the active arm received the Prevail Staff Intervention. The managers in the active arm also received the Prevail Managers Intervention. Participants' satisfaction and analysis of the Prevail Intervention were gathered by a bespoke questionnaire. Questionnaire measures of attitudes to mental health and mental health stigma were taken 1-2 weeks prior to the intervention and approximately 4 weeks post-intervention. Data relating to sickness absence were gathered via the official records in the time period 3-month post-intervention and for the same period 12 months earlier. RESULTS: Prevail was evaluated highly favourably by both the staff and their managers. Prevail produced significant reductions in self-stigma and anticipated stigma due to mental health difficulties. Crucially, sickness absence was significantly reduced by the Prevail Intervention. DISCUSSION: Prevail achieved its goals of producing a palatable and engaging intervention that altered staff's attitudes and stigmatic beliefs related to mental health and, crucially, produced a strong reduction in work-pace absenteeism. As the Prevail programme is aimed at common mental health problems and was not specialised to this particular workforce, the study provides the evidence-base for a mental health intervention programme that could be used by many organisations across the world. TRIAL REGISTRATION: ISRCTN12040087. Registered 04/05/2020. https://doi.org/10.1186/ISRCTN12040087 . A full protocol for the randomised control trial was published: Gray NS, Davies H, Snowden RJ: Reducing stigma and increasing workplace productivity due to mental health difficulties in a large government organization in the UK: a protocol for a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail). BMC Public Health 2020, 20(1):1-9.

A randomised controlled trial evaluating the Guide Cymru mental health literacy intervention programme in year 9 (age 13-14) school pupils in Wales.

BACKGROUND: Adolescent mental health has become a public health concern as 10-20% of adolescents have experiences with mental health problems. Improving mental health education is critical to reducing stigma and improving access to appropriate care when needed. Here we examine the impact of a mental health literacy programme (Guide Cymru) in young adolescents in the UK. A randomised controlled trial assessed the effectiveness of the Guide Cymru intervention. METHOD: A total of 1,926 pupils (860 males and 1066 females) aged 13-14 (year 9) took part in the study. The secondary schools were randomised into the active and control arms of the study. Teachers in the active arm of the study were trained on the Guide Cymru and then delivered the intervention to their pupils. Pupils in the active groups received six modules of mental health literacy (the Guide Cymru), and control schools received teaching as usual. Mental health literacy across several domains (e.g., knowledge, stigma, help-seeking intentions) were assessed both before and after the intervention. Data collection for the randomised controlled trial ran from September 2019 to March 2020. Multi-level modelling analysis was conducted to account for the clustered nature of the design. RESULTS: All aspects of mental health literacy, including mental health knowledge (g = 0.32), good mental health behaviours (g = 0.22), mental health stigmas (g = 0.16), intentions to seek help (g = 0.15), and avoidant coping (g = 0.14) improved after completing the Guide Cymru programme (ps < .001). DISCUSSION: The current study presents evidence for the Guide Cymru's effectiveness in improving secondary school pupils' mental health literacy. We demonstrate that providing teachers with appropriate resources and training to deliver the Guide Cymru programme within their classrooms can improve the mental health literacy of pupils. These findings have important implications for the beneficial impacts the secondary school system can have on reducing the burden of mental health problems at a critical point in a young person's life. TRIAL REGISTRATION: ISRCTN15462041. Registered 03/10/2019.

The Cardiff Self-Injury Inventory (English version): Convergent validity and psychometric properties.

Background and Aims: The Cardiff Self-Injury Inventory (CSII) is a short (1 min), relatively nonintrusive, measure of previous self-injury behaviors written in English. It measures self-injury with suicidal intent and without such intent, covers actions versus thoughts, and has two time periods (lifetime vs recent [defined as the last 3 months]). The study aimed to examine its psychometric properties and its relationship to more well-established measures. Methods: A UK community sample of 184 participants completed the CSII and two other measures of self-harming (Deliberate Self-Harm Inventory [DSHI] and Suicidal Behaviors Questionnaire-Revised [SBQ-R]) in March 2020-May 2020. Fifty participants also repeated these measurements 1-2 weeks later. Results: The CSII showed strong psychometric properties with internal reliability of 0.87 and a test-retest of 0.82. The subscales also showed strong psychometric properties. The CSII showed strong concurrent validity to the other measures of self-injury (SBQ-R, r = 0.70; DSHI, r = 0.81). A factor analysis supported the idea that there are two distinct components to the overall CSII score arising due to the distinction between suicidal and nonsuicidal behaviors. Conclusion: The CSII has good psychometric properties in this population and can be used as a fast, nonintrusive, measure of different self-injurious behaviors for clinical or research purposes.

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism.

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

The Stigma and Self-Stigma Scales for attitudes to mental health problems: Psychometric properties and its relationship to mental health problems and absenteeism.

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

A reduction in the pupil's response to affective sounds in psychopathy and related personality traits.

The pupil of the eye dilates in response to affective information, even if that information is not visual. We used this affective modulation of the pupil to examine the hypothesis that individuals with high traits of psychopathy have an insensitivity to emotional stimuli. We also examined general personality traits related to psychopathy. A sample of 120 healthy young men had their pupils monitored while they listened to sound clips that conveyed either neutral emotion (e.g., rain), negative emotion (e.g., a person screaming) or positive emotion (e.g., people laughing). Psychopathy and general personality traits were measured via self-report questionnaire. As expected, both the positive and negative emotional sounds produced greater dilation in the pupil size than neutral sounds. This affective modulation of the pupil was found to be reduced for the negative sounds for people high on the "callous/affective" components of psychopathy (the Affective facet of the SRP-4 and the Meanness scale of the TriPM) and the general personality traits of Reward Dependence and Cooperativeness. The results indicate that these callous traits of psychopathy and general personality may be underpinned by a reduction in the ability to effectively process or monitor emotional stimuli.

Automatic processing of emotional images and psychopathic personality traits.

Psychopathy is associated with a deficit in affective processes and might be reflected in the inability to extract the emotional content of a stimulus. Across two experiments, we measured the interference effect from emotional images that were irrelevant to the processing of simultaneous target stimuli and examined if this interference was moderated by psychometrically defined traits of psychopathy. In Experiment 1, we showed this emotional distraction effect was reduced as a function of psychopathic traits related to cold-heartedness and occurred for both positively- and negatively-valenced images. Experiment 2 attempted to test the automaticity of the effects by presenting the emotional stimuli briefly so that the emotion was difficult to report. Again, high visibility images produced strong effects that were moderated by the cold-heatedness/meanness traits of psychopathy, but the low-visibility images did not evoke the emotional distractor effect. Our results strongly support the notion that psychopathic traits related to cold-heartedness/meanness are associated with an inability to automatically process the emotional content of images.

The Role of Hope and Resilience in Protecting Against Suicidal thoughts and Behaviors During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has impacted the mental health and wellbeing of populations across the world. This study aimed to examine: (1) which specific aspects of the COVID-19 pandemic were associated with the presence of suicidal thoughts and behaviors, and (2) the extent to which participants' hopelessness and resilience moderated the relationship between COVID-19 related stress and suicidal thoughts and behaviors. METHOD: We administered an online survey to 12,989 adult (16+) participants across Wales from the 9th June to the 13th July 2020. Participants completed a series of questionnaires measuring the stressors they had experienced during the COVID-19 pandemic, their levels of hopelessness over the past two weeks, their levels of resilience, and whether they had experienced suicidal thoughts or behaviors since the onset of the COVID-19 pandemic. RESULTS: Our findings revealed that: (1) food insecurity, domestic abuse, relationship problems, redundancy, social isolation and financial problems were the COVID-19 related stressors most strongly associated with suicidal thoughts and behaviors, and (2) that both hopelessness and resilience moderated the relationship between COVID-19 stress and suicidal thoughts, such that the relationship between COVID-19 stress and the presence of suicidal thoughts was much stronger for individuals with high hopelessness and low resilience. CONCLUSIONS: These results highlight the aspects of the COVID-19 pandemic that are closely related to suicidal thoughts and behaviors and demonstrate the important role that hope for the future and resilience play in protecting individuals against the negative effects of the COVID-19 pandemic.HighlightsStressors caused by the pandemic are linked to increased suicidal thoughts.Hope protects individuals against the negative impact of the COVID-19 pandemic.Resilience also protects people from the negative impact of the COVID-19 pandemic.

Explicit and Implicit Self-esteem and Aggression: Differential Effects of Agency and Communion.

Previous work has shown that self-esteem is related to aggression and violence. However, self-esteem is a multidimensional construct, and so we isolated self-esteem related to agency (e.g., competence and assertiveness) and self-esteem related to communion (e.g., warmth and morality) using both explicit and implicit techniques and examined their relationship to two forms of aggression (proactive and reactive aggression) in two samples. In an undergraduate sample (N = 130), high levels of explicit agency were associated with increased aggression but only for those with low implicit agency. On the other hand, high levels of either explicit or implicit communion showed reduced proactive aggression, while high levels of explicit communion were also associated with low levels of reactive aggression. In a community sample of people with problems due to homelessness (N = 101), we found that high levels of explicit communion were also associated with lower levels of both forms of aggression. The results show that different aspects of self-esteem, namely agency and communion, have quite different relationships to aggression and that implicit measures of these self-evaluations are also important constructs in the prediction of aggression. Implicit measures of self-esteem could be used by clinicians to understand the motivations behind an individual's aggression and its management.

Secondary school students' perception of the online teaching experience during COVID-19: The impact on mental wellbeing and specific learning difficulties.

BACKGROUND: Student engagement and concentration is critical for successful learning. Due to the COVID-19 pandemic, there has been a dramatic increase in the use of online learning which may affect engagement and concentration, particularly for those students with specific learning difficulties. AIMS: Students would show lower scores on all the measures of student experience when judging these during online learning versus learning within the classroom. This negative impact of online learning on concentration, engagement, perceived learning, and self-worth compared to classroom education would be more significant for those with specific learning difficulties. The drop in student experience scores due to online learning would be associated with poorer mental well-being. SAMPLE: Four hundred seven pupils aged 11-18 years at a secondary education school in Wales. METHODS: A retrospective online survey comparing pupils' normal classroom experience to learning online during the first national lockdown in the United Kingdom (March-July 2020). RESULTS: Pupils' learning experiences (concentration, engagement, ability to learn, and self-worth from learning) were significantly lower for online learning compared to the classroom learning. These differences were more marked in students with specific learning difficulties. Perceived ability to learn and engage during classroom and online learning were also associated with mental well-being. CONCLUSIONS: The move to online learning appears to have affected students' ability to concentrate and engage in their schoolwork and appears to have reduced their ability to learn and get self-worth from their work. These decreases are associated with a decrease in mental well-being. The effects appear to be exacerbated in some students with specific learning difficulties.

Development and psychometric properties of the Knowledge and Attitudes to Mental Health Scales (KAMHS): a psychometric measure of mental health literacy in children and adolescents.

BACKGROUND: Adolescence is a crucial period for the acquisition of good mental health behaviours, which are the foundation for health and wellbeing in later life. Improved knowledge about mental health and improved help-seeking behaviours have been shown to lead to better mental health outcomes. Mental health literacy (MHL) is multifaceted (e.g., knowledge about symptoms, the stigma around mental health, good mental health practices, etc.). Measures are needed that can assess these different aspects of MHL. Measurement of mental health literacy is currently limited due to a lack of reported psychometric instruments with known psychometric properties. Given that most mental health problems start in early adolescence, a scale is needed that is reliable and valid in this age group. METHODS: The development and validation of the psychometric instrument (termed the Knowledge and Attitudes to Mental Health Scales: KAMHS) entailed two phases: 1) item generation based on an evidence-based intervention programme: The Guide; and 2) item reduction through exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) for factor structure and psychometric assessment. Participants were 559 Year 9 pupils in secondary schools across Wales aged between 13 and 14 years. RESULTS: Results from the CFA indicated an acceptable fit of the model to the data. The KAMHS showed good internal constancy and moderate test-retest validity (.40-.64). CONCLUSIONS: The final version of the KAMHS contains 50 items that are appropriate for use in children and adolescents. These results suggest that the KAMHS can be used over time to assess the efficacy of interventions aimed at increasing the mental health literacy of adolescent populations.

Psychological distress and resilience in first responders and health care workers during the COVID-19 pandemic.

During the COVID-19 pandemic, first responders and health care workers faced elevated virus-related risks through prolonged contacts with the public. Research suggests that these workers already experienced lower levels of psychological well-being linked to occupational risks. Thus, the pandemic's impact might have particularly affected mental health in these groups. This paper analysed data from a large-scale Welsh population study (N = 12,989) from June to July 2020. Levels of psychological distress were compared across various occupations, including police, fire and rescue, and NHS health care workers. Resilience was also indexed, and its role considered as a protective factor for psychological distress. Surprisingly, health care workers reported lower distress levels than the general population. Further, fire and rescue and police groups had lower distress than most groups and significantly higher resilience. Within police officers, higher resilience levels were protective for distress. Fire and rescue workers were half as likely as others to report distress, even accounting for demographic factors and resilience. The findings offer an optimistic view of psychological resilience in these critical occupations. They illustrate potential benefits to one's mental health of playing a crucial societal role during crises and reiterate the importance of enhancing resilience within groups who encounter high-risk situations daily. Practitioner points: Our findings provide evidence that health care workers and first responders showed lower levels of psychological distress than the general population during the first period of lockdown due to the COVID-19 pandemic in the United Kingdom. This may indicate that playing a critical role in society during an episode of crisis, and acting to help others, may be protective of one's own mental health.The research also provides an optimistic view of the psychological resilience of critical first responders and health care workers during a period early on in the COVID-19 pandemic (June-July 2020). This highlights the benefits of fostering resilience in those working within high-risk first responder and health care occupations.

Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP).

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk. Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder. Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission. Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93-0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample. Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

Explicit and Implicit Hopelessness and Self-injury.

OBJECTIVE: This study examined the relationship between explicit and implicit measures of hopelessness and self-injurious behavior (defined here as self-harming or suicidal actions and thoughts). METHOD: A community sample of 267 participants completed explicit measures of hopelessness (Beck's Hopelessness Scale and a Feeling Thermometer), an implicit measure of hopelessness (Hopelessness Implicit Association Test), and a self-report measure of their history of self-injurious behavior. RESULTS: The results showed that high levels of hopelessness, measured both explicitly or implicitly, were associated with a past and recent history of self-injury. However, there was also an interaction between the implicit and explicit measures such that explicit hopelessness was more strongly predictive of self-injury in people with high levels of implicit hopelessness. CONCLUSION: The findings show that the implicit measurement of hopelessness can help predict past and recent self-injury beyond what explicit measures of hopelessness currently achieve and could be used in the assessment of risk of both self-harming and suicidal behaviors.

The Triarchic Model of Psychopathy and Antisocial Behavior: Results From an Offender Population With Personality Disorder.

The triarchic model posits that psychopathy is a combination of phenotypes related to boldness, meanness, and disinhibition. We examined how each of these phenotypes of psychopathy related to past violence and antisocial behavior and to behavior within the prison. The sample consisted of men (n = 108) with a history of serious offending and a diagnosis of personality disorder at the point of admission to a prison serving as a therapeutic community. We took four indices of violence and antisocial behavior, (a) self-report of lifetime proactive and reaction aggression, (b) criminal convictions prior to admission to the prison, (c) exclusion from the prison within 12 months due to rule breaking, and (d) behavior within the first 12 months of admission to the unit. The constructs of the triarchic model, as assessed by the triarchic psychopathy measure (TriPM), were strong predictors of self-reported aggression, with disinhibition being related to both proactive and reactive aggression, whereas boldness was related to proactive aggression alone. Past criminal convictions were also associated with disinhibition, except for convictions for violent behavior. Both meanness and disinhibition were predictive of exclusion from the prison within 12 months for rule-breaking behavior and of aggressive behavior within the prison. The triarchic model of psychopathy is associated with past antisocial behavior and is predictive of antisocial behaviors within the prison, and the different constructs of the triarchic model are associated with different manifestations of antisocial behavior. The TriPM holds great promise for improved assessment and enhanced understanding of psychopathic personality within institutions and can facilitate offender management via improved phenotypic analysis of boldness, meanness, and disinhibition.

Self-Esteem, Narcissism, and Aggression: Different Types of Self-Esteem Predict Different Types of Aggression.

The aim of this study was to examine the relationship between self-esteem, narcissism, and measures of proactive and reactive aggression in two large community samples of young adults from two countries (the United Kingdom and Malaysia). Self-esteem and narcissism were measured through the Multidimensional Self-Esteem Inventory and the Narcissistic Personality Inventory, whereas aggression was measured by the Reactive-Proactive Aggression Questionnaire in 501 young adults with approximately equal numbers of men and women. In both countries, low levels of self-esteem were associated with reactive aggression while high levels of narcissism were associated with proactive aggression. Although this pattern was similar for both genders, the associations between both types of self-evaluation and proactive aggression were greater for men. The results suggest that people with low self-esteem are prone to greater reactive aggression due to anger and hostility, whereas those with high levels of narcissism can act with deliberate, planned aggression to achieve a goal. These effects appear stable across gender and culture.

The Influence of the COVID-19 Pandemic on Mental Well-Being and Psychological Distress: Impact Upon a Single Country.

The COVID-19 pandemic is likely to have affected the psychological well-being and mental health of many people. Data on prevalence rates of mental health problems are needed for mental health service planning. Psychological well-being and prevalence of clinically significant mental distress were measured in a large sample from Wales 11-16 weeks into lockdown and compared to population-based data collected in 2019 before the COVID-19 pandemic. Data were collected using an online survey disseminated across Wales and open to adults (age 16+) from 9th June to 13th July 2020. Psychological well-being was indexed via the Warwick-Edinburgh Mental Well-being Scale, and psychological distress was indexed via the K10. Data from 12,989 people who took part in this study were compared to that from April 2018 - March 2019, gathered by the National Survey for Wales (N = 11,922). Well-being showed a large decrease from 2019 levels. Clinically significant psychological distress was found in around 50% of the population (men = 47.4%, women = 58.6%), with around 20% showing "severe" effects (men = 17.0%, women = 20.9%): a 3-4-fold increase in prevalence. Most affected were young people, women, and those in deprived areas. By June-July 2020 the COVID-19 pandemic had dramatic effects on the mental health of people living in Wales (and by implication those in the UK and beyond). The effects are larger than previous reports. This probably reflects that the current data were taken deeper into the lockdown period than previous evaluations. Mental health services need to prepare for this wave of mental health problems with an emphasis on younger adults, women, and in areas of greater deprivation.

Reducing stigma and increasing workplace productivity due to mental health difficulties in a large government organization in the UK: a protocol for a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail).

BACKGROUND: Common mental disorders are the leading cause of workplace absences. While the reasons for this are multifarious, there is little doubt that stigma related to common mental disorder plays a large role in sickness absence and in poor help-seeking. Frequently both managers and staff are unsure of how to approach and intervene with mental health related problems. We have therefore devised a mental health intervention programme (Prevail) that aims to reduce stigma and to educate staff about evidence-based low intensity psychological interventions. These can be used by the individual, as well as in collaboration with managers via co-production of problem-focussed solutions, with the aim of improving mental health, reducing sickness absence, and increasing workplace productivity. METHODS: This two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of Prevail. Eighty managers at a large UK government institution (the DVLA) and their teams (approximately 960 employees) will be randomised into the active intervention group or control (employment as usual) arms of the study. All participants will be invited to complete a series of questionnaires related to mental health stigma, their current and past mental health, and their recent workplace productivity (absenteeism and presenteeism). All employees in the active arm will receive the Prevail Staff intervention, which covers stigma reduction and includes psychoeducation about evidence-based low intensity psychological interventions for common mental disorder. The managers in the active arm will also receive the Prevail Managers programme which covers communication skills, problem formulation, and problem-solving skills. The questionnaire battery will then be given to both groups again 4 weeks post training, and 12 months post-training. Official records of absenteeism from Human Resources will also be gathered from both active and control groups at 12 months post-training. DISCUSSION: The treatment trial aims to evaluate if Prevail reduces mental health related stigma (of a number of forms), increases help-seeking behaviours, and increases workplace productivity (via decreased absenteeism and presenteeism). TRIAL REGISTRATION: ISRCTN12040087. Retrospectively registered 04/05/2020.

Enhanced emotional response to both negative and positive images in post-traumatic stress disorder: Evidence from pupillometry.

Post-traumatic stress disorder (PTSD) is characterised by alterations in the function of the autonomic nervous system. However, it is unclear if this dysfunction is threat-related or related to arousing stimuli in general. Pupillometry offers a simple non-invasive measure of ANS activity that can separate parasympathetic and sympathetic arousal. Participants viewed images with emotional or neutral content: 20 met diagnostic criteria for PTSD, 28 were trauma-exposed (but with no PTSD), and 17 were controls. Initial pupil constriction (a marker of parasympathetic function) was reduced for the PTSD group, while dilation due to the emotional content of the image (a marker of sympathetic activity) was greater in the PTSD group. Individuals with PTSD demonstrated enhanced physiological arousal to both threat-related and positive images. The results suggest reduced parasympathetic arousal and increased sympathetic arousal in the autonomic nervous system, which has been linked to a range of adverse health outcomes in PTSD.