Adult Mental Health Research Articles

Identifying complex emotional and relational needs of service users in Later Life CMHTs within the Greater Manchester Mental Health NHS Foundation Trust

The Community Mental Health Transformation Agenda places a focus on supporting adults and older adults with severe and enduring mental health difficulties, including care for older adults with complex emotional and relational needs (CERN). Current research has paid little attention to CERN in later life. Studies suggest that older adults with CERN present differently to younger adults. This means services may not be identifying and meeting the needs of these individuals. The aim of this scoping exercise was to understand the prevalence of CERN in older adult community mental health services in Greater Manchester. Data was collected on 347 service users under the Care Programme Approach with later life community mental health teams in Greater Manchester. Data was gathered from the Trust electronic record system and interviews with care co-ordinators. Findings revealed that services users had high levels of complex need, including high levels of service use and high levels of risk, especially for self-neglect. Findings aligned with scoping exercises conducted in other Trusts and provided a better understanding of the needs of this population.

The relationship of childhood maltreatment, adult sexual victimization, depressed mood and symptoms of trauma with fear of childbirth

Background: Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB. Methods: This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis. Results: Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery. Limitations: Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias. Conclusions: Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

Young People Transitioning From Child and Adolescent to Adult Mental Health Services: A Qualitative Systematic Review.

To critically synthesise the literature on the lived experience of young adults about their transition to adult mental health services including the perspectives of key people in their world: parents, carers and clinicians. Young people within child and adolescent mental health services are usually required to transition to adult mental health services at the age of 18, despite evidence showing cognitive and emotional development impacted by childhood trauma, illness and adverse life events. This qualitative systematic review searched relevant electronic databases, policy documents, grey literature and theses examining original qualitative peer-reviewed studies published from 2009 to 2022 in English. The process utilised the PRISMA guidelines and the quality of papers assessed by the JBI critical appraisal tool. Nine papers met the criteria for inclusion in the review. The results indicate that qualitative research listening to the voices of young people transitioning to adult mental health services is a rarity. Even fewer papers examine the perspectives of key people in their lives: this review has critically synthesised the literature on the lived experience of young adults about their transition to adult mental health services including the perspectives of key people in their world: parents, carers and clinicians. The main themes identified include: age 18 is not a helpful trigger to transition; young people want more individualised planning; parents want more involvement and clinicians open up about a challenging nexus with adult mental health services.

Normalising the Implementation of Pharmacogenomic (PGx) Testing in Adult Mental Health Settings: A Theory-Based Systematic Review.

Pharmacogenomic (PGx) testing can help personalise psychiatric prescribing and improve on the currently adopted trial-and-error prescribing approach. However, widespread implementation is yet to occur. Understanding factors influencing implementation is pertinent to the psychiatric PGx field. Normalisation Process Theory (NPT) seeks to understand the work involved during intervention implementation and is used by this review (PROSPERO: CRD42023399926) to explore factors influencing PGx implementation in psychiatry. Four databases were systematically searched for relevant records and assessed for eligibility following PRISMA guidance. The QuADS tool was applied during quality assessment of included records. Using an abductive approach to codebook thematic analysis, barrier and facilitator themes were developed using NPT as a theoretical framework. Twenty-nine records were included in the data synthesis. Key barrier themes included a PGx knowledge gap, a lack of consensus in policy and guidance, and uncertainty towards the use of PGx. Facilitator themes included an interest in PGx use as a new and improved approach to prescribing, a desire for a multidisciplinary approach to PGx implementation, and the importance of fostering a climate for PGx implementation. Using NPT, this novel review systematically summarises the literature in the psychiatric PGx implementation field. The findings highlight a need to develop national policies on using PGx, and an education and training workforce plan for mental health professionals. By understanding factors influencing implementation, the findings help to address the psychiatric PGx implementation gap. This helps move clinical practice closer towards a personalised psychotropic prescribing approach and associated improvements in patient outcomes. Future policy and research should focus on the appraisal of PGx implementation in psychiatry and the role of pharmacists in PGx service design, implementation, and delivery.

The association between neighborhood socioeconomic deprivation and mental health in low- and middle-income countries: A scoping review.

Environmental research on mental health primarily originates from high-income countries, while information about the rest of the world remains limited. This study examined: (1) the available published research evidence regarding the association between neighborhood-level deprivation and indicators of mental health and illness in low- and middle-income countries (LMICs), and (2) the gaps in the relevant research in LMIC settings that should be addressed in future studies. First, we systematically searched for relevant primary studies in electronic databases (Ovid Medline, Scopus, Socindex, and PsycINFO) and citations in the reference lists. Then, a two-stage screening procedure was employed to select the relevant studies by screening the titles and abstracts and reviewing the selected full texts by independent researchers. After charting the data from the selected study reports, we collated, summarized, and discussed the results. We retrieved 51 studies across 19 LMICs, with only one study originating from a low-income country. Most studies focused on adult mental health topics and few explored children's mental health. Notably, a significant majority of these studies (N = 37) reported a positive association between neighborhood deprivation and mental health/disorder. However, the research methods used varied significantly, and there were several methodological limitations. This review highlights the need for more original studies in LMICs on the association between neighborhood deprivation and mental health, employing stronger methodologies.

Long-term effects of grandparental child neglect on adult grandchildren's mental health: A three-generation study

Child neglect is a significant social problem with severe consequences for individuals and society. This study explores how intergenerational transmission of grandparental child neglect affects grandchildren's mental health in adulthood. We utilize a three-generational dataset from the Tromsø Study and estimate a linear probability model to find the distinct roles of both maternal and paternal grandparents. We test the additive risk hypothesis for continuous, intergenerational effects of child neglect in both the maternal and paternal lineages. Furthermore, we use structural equation modeling to test how sequential exposures to neglect across generations ultimately bear on adult mental health outcomes. Our results confirm the additive risk hypothesis but only for maternal grandparents: our findings show that only maternal parents' neglectful parenting is associated with an increased probability of depression in their grandchildren, conditional on whether their parents neglected them. These results contribute to research on intergenerational transmission by the finding that additive risks of child maltreatment flow down generations mainly through maternal lineages.

Trauma History in a Medium-Secure Adult Male Forensic Mental Health Setting

Forensic services have shifted their focus to the importance of forensic practice becoming more trauma informed. Trauma exposure is pervasive in forensic mental health populations and has been found to negatively impact the course of severe mental illness (SMI) and increase risk of violence. This study aimed to explore the trauma histories of adult male inpatients in a medium-secure psychiatric hospital, and examine childhood and adulthood trauma as predictors of diagnoses, self-harm, suicidality, hospital re-admissions, substance use, and nature of offense. The case files of 85 male patients in a medium secure unit in the UK were reviewed. Eighty-seven percent of patients had a schizophrenia diagnosis and 86% had extensive trauma histories, the most common trauma type being physical violence in childhood (44.7%). One patient had a PTSD diagnosis. Logistic regressions demonstrated that cumulative childhood and adulthood trauma significantly increased the odds of self-harm. Cumulative childhood trauma exposure was found to decrease the likelihood of having a schizophrenia diagnosis. There is a serious under-recognition of the extent and consequences of trauma exposure; trauma histories are likely greater than the findings of this study and existing literature suggests. Implications for clinical practice, trauma-informed care (TiC), and future research are proposed.

Genetic diagnostics of mental health disorders in adulthood

This review article provides insights into the role of genetic diagnostics in adult mental health disorders. The importance of genetic factors in the development of mental illnesses, from rare genetic syndromes to common complex genetic disorders, is described. Current clinical characteristics that may warrant agenetic diagnostic work-up are highlighted, including intellectual disability, autism spectrum disorders and severe psychiatric conditions with specific comorbidities, such as organ malformations or epilepsy. The review discusses when genetic diagnostics are recommended according to current guidelines as well as situations where they might be considered even in the absence of explicit guideline recommendations. This is followed by an overview of the procedures and the currently used diagnostic methods. Current limitations and possible developments in the field of genetic diagnostics in psychiatry are discussed, including the fact that, for many mental health conditions, genetic testing is not yet part of standard clinical practice; however, in summary genetic causes should be considered more frequently in certain clinical constellations, and genetic diagnostics and counselling should be offered where appropriate.

Evaluating the association between placenta DNA methylation and cognitive functions in the offspring

The placenta plays a crucial role in protecting the fetus from environmental harm and supports the development of its brain. In fact, compromised placental function could predispose an individual to neurodevelopmental disorders. Placental epigenetic modifications, including DNA methylation, could be considered a proxy of placental function and thus plausible mediators of the association between intrauterine environmental exposures and genetics, and childhood and adult mental health. Although neurodevelopmental disorders such as autism spectrum disorder have been investigated in relation to placenta DNA methylation, no studies have addressed the association between placenta DNA methylation and child’s cognitive functions. Thus, our goal here was to investigate whether the placental DNA methylation profile measured using the Illumina EPIC array is associated with three different cognitive domains (namely verbal score, perceptive performance score, and general cognitive score) assessed by the McCarthy Scales of Children’s functions in childhood at age 4. To this end, we conducted epigenome-wide association analyses, including data from 255 mother-child pairs within the INMA project, and performed a follow-up functional analysis to help the interpretation of the findings. After multiple-testing correction, we found that methylation at 4 CpGs (cg1548200, cg02986379, cg00866476, and cg14113931) was significantly associated with the general cognitive score, and 2 distinct differentially methylated regions (DMRs) (including 27 CpGs) were significantly associated with each cognitive dimension. Interestingly, the genes annotated to these CpGs, such as DAB2, CEP76, PSMG2, or MECOM, are involved in placenta, fetal, and brain development. Moreover, functional enrichment analyses of suggestive CpGs (p < 1 × 10−4) revealed gene sets involved in placenta development, fetus formation, and brain growth. These findings suggest that placental DNA methylation could be a mechanism contributing to the alteration of important pathways in the placenta that have a consequence on the offspring’s brain development and cognitive function.

Negative LGBTQ+ News Media Means Bad News for LGBTQ+ Young Adult Mental Health

Negative LGBTQ+ News Media Means Bad News for LGBTQ+ Young Adult Mental Health

Caught in the Crossfire: Ecuador’s Safety Crisis Impact on Teen and Young Adult Mental Health

Introduction: During the past decade, Ecuador has become one of the most dangerous countries in Latin America, with a significant rise in violence impacting mental health. This study investigates hospital admissions for mood disorders among adolescents and young adults in Ecuador from 2021 to 2022. Methods: We used public access data from the National Institute of Census and Statistics (INEC) to analyze hospital admissions for mood disorders in individuals aged 12 to 21, categorized using the International Classification of Diseases (ICD-10) codes F30 to F39. Results: Results show a female predominance in admissions, with a female-to-male ratio of 3:1 by 2022. Admissions for depressive episodes accounted for 66.5% of cases, peaking in 2022. The regions with the highest admission rates were the Galapagos Islands and Pichincha. A notable reduction in admissions was observed in 2020, likely due to the COVID-19 pandemic´s impact on healthcare access. Discussion: The study's findings highlight significant gender disparities, diagnostic trends and regional differences in mood disorder admissions. The increasing trend, particularly for depressive episodes, underscores the need for enhanced mental health resources. Conclusion: The study concludes that the escalation of violence in Ecuador significantly impacts mental health, emphasizing the urgency of addressing social determinants of health and focussing efforts on regions most affected by conflict.

Factors influencing young people’s transitions from child to adult mental health services in Wales

ObjectivesThis presentation provides an overview of young peoples’ transitions from child to adult mental health services in Wales. Transitions are unstable times where need for support can be greatest, yet many young adults fail to qualify for ongoing specialist support. Young people with social care needs and/or living in poverty face an increased likelihood of mental ill health. These underlying factors of disadvantage are modifiable and can be considered ‘solution linked variables’ (O’Campo and Dunn, 2011) of particular relevance in public health policy development. ApproachThis study positions intersectionality theory within a quantitative, secondary data methodology. Descriptive statistics and logistic regression models were used to elicit how social care need, deprivation, mental health diagnoses, gender and ethnicity might interact to influence likelihood of transition from child to adult mental health services. Sequence analyses developed pathway typologies from varying patterns of mental health service access. ResultsNovel findings reflecting the interactional influences of differing social care need and area levels of deprivation on child to adult mental health service transitions will be presented alongside results controlling for gender, ethnicity and mental health diagnoses. The value of mapping typologies of mental health service use will be discussed in relation to the findings. ConclusionsInterim findings suggest greatly increased mental health service use and differing patterns of access for young people with social care needs and/or living in the most deprived areas as they transition to adulthood. The implications for service development and delivery in times of unprecedented demand are explored.

A Prospective Examination of Mental Health Trajectories of Disaster-Exposed Young Adults in the COVID-19 Pandemic.

This longitudinal study examines young adult mental health (MH) trajectories after exposure to natural disasters (i.e., hurricanes, wildfires, mudslides) across four waves, two pre- and two during the COVID-19 pandemic. Participants (n = 205) answered questions about anxiety, depression, and post-traumatic stress symptoms (PTSSs) across Waves (Ws) s 1-4 and pre-pandemic factors (prior trauma history, disaster exposure, life stressors since disaster) at Wave (W) 1. Hierarchical linear modeling was conducted to examine MH trajectories and associations with pre-pandemic factors. Only the PTSS trajectory significantly differed across all Ws, with the largest increase between Ws 2 and 3 (pre- and during-pandemic time points). Prior trauma history and life stressors since the disaster were significantly associated with all MH trajectory intercepts but not growth rates.

Protocols for transitioning to adult mental health services for adolescents with ADHD

BackgroundFor Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are essential. While some guidelines are available, they do not always consider the effective workload and scarce resources. In Italy, very few guidelines are currently available, and they do not adhere to common standards, possibly leading to non-uniform use.MethodsThe present study analyzes 6 protocols collected from the 21 Italian services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. The protocols’ content is described, and a comparison with the National Institute for Clinical Health and Excellence (NICE) guidelines is carried out to determine whether the eight NICE fundamental dimensions were present.ResultsIn line with the NICE guidelines, the dimensions addresses in the 6 analyzed documents are: early transition planning (although with variability in age criteria) (6/6), individualized planning (5/6), and the evaluation of transfer needs (5/6). All protocols also foresee joint meetings between child and adult services. The need to include the families is considered by 4 out of 6 protocols, while monitoring (2/6), and training programs (1/6) are less encompassed. In general, a highly heterogeneous picture emerges in terms of quality and quantity of regulations provided.ConclusionsWhile some solid points and core elements are in common with international guidelines, the content’s variability highlights the need to standardize practices. Finally, future protocols should adhere more to the patients’ needs and the resources available to clinicians.

Domestic and Family Violence Screening and Response: A Prospective, Cross-Sectional, Mixed Methods Survey in Private Mental Health Clients.

Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross-sectional survey of adult inpatient mental health consumers was employed. Sixty-two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert-type and categorical responses were collated and analysed descriptively (count and percentage). Free-text responses were analysed using qualitative description within a content analysis framework. Sixty-five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty-three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow-up, increasing psychology support levels and safety planning.

From Adolescence to Adulthood: Understanding Care Trajectories in an Early Detection and Intervention Centre in France.

Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness. This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively. The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre. The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.

Economic impact of a vision-based patient monitoring system across five NHS mental health trusts.

A vision-based patient monitoring system (VBPMS), Oxevision, has been introduced in approximately half of National Health Service (NHS) mental health trusts in England. A VBPMS is an assistive tool that supports patient safety by enabling non-contact physiological and physical monitoring. The system aims to help staff deliver safer, higher-quality and more efficient care. This paper summarises the potential health economic impact of using a VBPMS to support clinical practice in two inpatient settings: acute mental health and older adult mental health services. The economic model used a cost calculator approach to evaluate the potential impact of introducing a VBPMS into clinical practice, compared with clinical practice without a VBPMS. The analysis captured the cost differences in night-time observations, one-to-one continuous observations, self-harm incidents, and bedroom falls at night, including those resulting in A&E visits and emergency service callouts. The analysis is based on before and after studies conducted at five mental health NHS trusts, including acute mental health and older adult mental health services. Our findings indicate that the use of a VBPMS results in more efficient night-time observations and reductions in one-to-one observations, self-harm incidents, bedroom falls at night, and A&E visits and emergency service callouts from night-time falls. Substantial staff time in acute mental health and older adult mental health services is spent performing night-time observations, one-to-one observations, and managing incidents. The use of a VBPMS could lead to cost savings and a positive return on investment for NHS mental health trusts. The results do not incorporate all of the potential benefits associated with the use of a VBPMS, such as reductions in medication and length of hospital stay, plus the potential to avoid adverse events which would otherwise have a detrimental impact on a patient's quality of life.

Emerging Adult Life Satisfaction and Mental Health: The Mediating Role of Self-Compassion and Social Support

Emerging adulthood (EA) is a time of possibilities, self-exploration, and personal growth. However, EA college students experience a high prevalence of mental illness and low engagement in mental health treatment. It is vital to find sustainable ways to increase life satisfaction despite mental distress. This study examined the mediating effects of social support and self-compassion on mental distress and life satisfaction among 200 EA college students. The parallel mediation revealed that self-compassion and social support significantly reduced the negative impact of mental distress on life satisfaction. A follow-up regression identified the self-compassion subscales common humanity (β = .17, p&lt;. 01), and reversed scored self-judgement (β = .13, p&lt;. 05), along with social support from friends (β = .17, p&lt;. 01), and family (β = .32, p&lt;. 01), as predictors of life satisfaction. For EA students experiencing anxiety, depression, and loneliness, self-kindness and accepting that life struggles are a common human experience, coupled with support from family and friends, can improve mental health and life satisfaction.

Implementing Connecting People in Adult Mental Health Social Work Practice: A Thematic Analysis of Postgraduate Student Assessed Placement Reports

Implementing Connecting People in Adult Mental Health Social Work Practice: A Thematic Analysis of Postgraduate Student Assessed Placement Reports

The unequal impacts of the COVID-19 pandemic on young adults' mental health. Predictors of vulnerability and resilience using longitudinal birth cohort data in the UK.

Previous studies have demonstrated deteriorations in young adult mental health during the COVID-19 pandemic, but evidence suggests heterogeneity in the mental health impacts of the pandemic. We sought to identify factors which may predict changes in psychological distress and wellbeing during the COVID-19 pandemic in UK young adults. A total of 2607 young adults from the Millennium Cohort Study were included. Psychological distress and mental wellbeing were measured using the Kessler-6 and Short Warwick-Edinburgh Mental Wellbeing Scale, respectively. Assessment occurred at three timepoints between the ages of 17-19: 2018/19 (pre-COVID Baseline), May 2020 (COVID Wave 1) and September/October 2020 (COVID Wave 2). Latent change score models were used to study change in distress and wellbeing across the study period, as well as the impact of sex, relative family poverty, parental education, preexisting mental health difficulties and perceived social support on these changes. The latent change score models suggested both distress and wellbeing tended to increase across the study period. Being female and in relative poverty predicted greater increases in distress and/or poorer wellbeing. Higher levels of parental education and greater perceived social support were protective against increased distress and associated with improved wellbeing. The impact of the COVID-19 pandemic on UK young adult mental health is complex. We provide further evidence for a distinction between symptoms of poor mental health and wellbeing. Research is urgently needed to assess the long-term impacts of the COVID-19 pandemic on the mental health and wellbeing of young people, particularly in more vulnerable groups.