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BACKGROUND Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50 per cent higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviours are associated with reduced anxiety in their children. A brief UK-based group-based intervention delivered to parents within the UK National Health Service led to a 16 per cent reduction in children meeting criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a nine-module online version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. OBJECTIVE To evaluate the feasibility of delivering a brief online intervention for parents and assess its effectiveness in reducing child anxiety symptoms. METHODS A randomised controlled trial (RCT) of a community sample of 1,754 parents with self-identified high levels of anxiety with a child aged 2-11. Parents in the intervention arm to receive access to the online course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection at 6 and 9-21 months. Intention to treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms and wellbeing; parental anxiety, wellbeing; and parenting behaviours. RESULTS Funded in April 2020, recruitment started in February 2021 and projected to end October 2022. CONCLUSIONS The results of the RCT will provide evidence on the utility of an online course in preventing intergenerational transmission of anxiety and increase understanding of familial anxiety. CLINICALTRIAL Prospectively registered on ClinicalTrials.Gov NCT04755933 on Feb 16th 2021.

Sabir Hossain,1 Shilen Shah,1 Jonathan Scott,1 Abigail Dunn,1 Alexander W Hartland,1 Sonia Hudson,1 Jo-Anne Johnson2 1Medical Education Department, Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, CM1 7ET, UK; 2School of Medicine, Anglia Ruskin University, Chelmsford, CM1 1SQ, UKCorrespondence: Sabir Hossain, Medical Education Department, Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Chelmsford, CM1 7ET, UK, Tel +44 1245 362000, Email sabir.hossain@doctors.org.uk View the original paper by Dr Hossain and colleagues This is in response to the Letter to the Editor

IntroductionThe National Institute for Health and Care Excellence (NICE) guidelines acknowledge the importance of the parent–infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under 1 year. This study explores the acceptability and psychometric properties of a co-developed tool, ‘Me and My Baby’ (MaMB).Study designA cross-sectional design was applied. The MaMB was administered universally (in two sites) with mothers during routine 6–8-week Health Visitor contacts. The sample comprised 467 mothers (434 MaMB completers and 33 ‘non-completers’). Dimensionality of instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modeling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of ‘fundamental measurement’. Tool acceptability was evaluated via completion rates and comparing ‘completers’ and ‘non-completers’ demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarized. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies.ResultsHigh completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially (>0.4) on a single underlying factor (latent variable). The item response modeling showed that most MaMB items fitted the Rasch model. (Rasch) item reliability was high (0.94) yet the test yielded little information on each respondent, as highlighted by the relatively low ‘person separation index’ of 0.1.Conclusion and next stepsMaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with ‘enriched population samples’ to include higher-need/risk families. The MaMB tool may benefit from reduced response categories (from four to three) and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions.

Background: Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful.\ud \ud Aim: To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them.\ud \ud Methods: Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison.\ud \ud Results: Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents.\ud \ud Conclusion: This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given.

Quarter-life crisis (QLC) is a popular term for developmental crisis episodes that occur during early adulthood (18–30). Our aim was to explore what linguistic themes are associated with this phenomenon as discussed on social media. We analyzed 1.5 million tweets written by over 1,400 users from the United Kingdom and United States that referred to QLC, comparing their posts to those used by a control set of users who were matched by age, gender and period of activity. Logistic regression was used to uncover significant associations between words, topics, and sentiments of users and QLC, controlling for demographics. Users who refer to a QLC were found to post more about feeling mixed emotions, feeling stuck, wanting change, career, illness, school, and family. Their language tended to be focused on the future. Of 20 terms selected according to early adult crisis theory, 16 were mentioned by the QLC group more than the control group. The insights from this study could be used by clinicians and coaches to better understand the developmental challenges faced by young adults and how these are portrayed naturalistically in the language of social media.

Many interventions that are delivered within public health services have little evidence of effect. Evaluating interventions that are being delivered as a part of usual practice offers opportunities to improve the evidence base of public health. However, such evaluation is challenging and requires the integration of research into system-wide practice. The Born in Bradford’s Better Start experimental birth cohort offers an opportunity to efficiently evaluate multiple complex community interventions to improve the health, wellbeing and development of children aged 0–3 years. Based on the learning from this programme, this paper offers a pragmatic and practical guide to researchers, public health commissioners and service providers to enable them to integrate research into their everyday practice, thus enabling relevant and robust evaluations within a complex and changing system. Using the principles of co-production the key challenges of integrating research and practice were identified, and appropriate strategies to overcome these, developed across five key stages: 1) Community and stakeholder engagement; 2) Intervention design; 3) Optimising routinely collected data; 4) Monitoring implementation; and 5) Evaluation. As a result of our learning we have developed comprehensive toolkits ( https://borninbradford.nhs.uk/what-we-do/pregnancy-early-years/toolkit/ ) including: an operational guide through the service design process; an implementation and monitoring guide; and an evaluation framework. The evaluation framework incorporates implementation evaluations to enable understanding of intervention performance in practice, and quasi experimental approaches to infer causal effects in a timely manner. We also offer strategies to harness routinely collected data to enhance the efficiency and affordability of evaluations that are directly relevant to policy and practice. These strategies and tools will help researchers, commissioners and service providers to work together to evaluate interventions delivered in real-life settings. More importantly, however, we hope that they will support the development of a connected system that empowers practitioners and commissioners to embed innovation and improvement into their own practice, thus enabling them to learn, evaluate and improve their own services.

Admiration is a social emotion that is developmentally formative in emerging adulthood; admired adults act as mentors, role models, and sources of inspiration to this age-group. The present study explored who and what emerging adults admire in their elders, across four countries (UK, Iran, China, and Russia). A total of 525 participants provided written descriptions of an admired figure. Across all cultures, care and generativity was the most common theme. Cross-cultural differences emerged for the themes of limitations and difficulties (most prevalent in China), autonomy and assertiveness (most prevalent in Russia), intellect and education (most prevalent in Russia), and religion and spirituality (most prevalent in Iran). Males and females in the UK and Russia tended to select admired figures of their own sex, but in Iran and China both male and female participants selected more male than female figures. The findings suggest a common thematic core to admiration in emerging adulthood combined with culturally specific features.