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Mental health difficulties are common in children and young people with chronic health conditions, but many of those in need do not access evidence-based psychological treatments. The study aim was to evaluate the clinical effectiveness of integrated mental health treatment for children and young people with epilepsy, a common chronic health condition known to be associated with a particularly high rate of co-occurring mental health difficulties.

Evidence suggests that culturally adapted psychological interventions have some benefits in treating diverse ethnic groups. However, the effect of such cultural adaptions specifically in Chinese ethnic groups has not been thoroughly reviewed. We aimed to systematically assess the evidence for the efficacy of different cultural adaptations in treating common mental disorders in people of Chinese descent (ie, ethnic Chinese populations).

We describe post-COVID symptomatology in a non-hospitalised, national sample of adolescents aged 11–17 years with PCR-confirmed SARS-CoV-2 infection compared with matched adolescents with negative PCR status.

ObjectivesTo describe the physical and mental health of children and young people (CYP) 6 months after infection with SARS-CoV-2 and explore whether this varies by COVID-19 vaccination.DesignA non-hospitalised, national cohort of people aged 11–17 years old with PCR-confirmed SARS-CoV-2 infection and PCR negatives matched at study invitation, by age, sex, region and date of testing who completed questionnaires 6 months after PCR testing. The questionnaire included 21 symptoms and standardised scales (eg, EQ-5D-Y and Chalder Fatigue Scale).Results6407 test-positive and 6542 test-negative CYP completed the 6-month questionnaire: 60.9% of test-positive vs 43.2% of test-negative CYP reported at least one symptom 6 months post-test; 27.6% of test-positive vs 15.9% of test-negative CYP reported 3+ symptoms. Common symptoms at 6 months were tiredness and shortness of breath among both test-positive and test-negative CYP; however, the prevalence of both was higher in test-positive (38.4% and 22.8%, respectively) compared with test-negative CYP (26.7% and 10.9%, respectively). 24.5% test-positive vs 17.8% test-negative CYP met the Delphi research definition of long COVID. Mental health, well-being, fatigue and health-related quality of life scores were similar among test-positive and test-negative CYP 6 months post-test. Similarly, symptomatology was similar among COVID-19-vaccinated and COVID-19-unvaccinated test-positive and test-negative CYP.ConclusionsSix-months post-PCR testing, CYP who tested positive for SARS-CoV-2 had similar symptoms to those who tested negative, but test-positive CYP had higher symptom prevalence. Mental health, well-being, fatigue and health-related quality of life were similar among test-positive and test-negative CYP, and symptoms at 6 months were similar in COVID-19 vaccinated and unvaccinated.Trial registration numberISRCTN 34804192.

Eating disorders are prevalent among children and young people, yet accessing effective treatment often involves significant delays. Guided self-help interventions, which are shorter and require less therapist involvement than standard treatments, could help bridge this gap. However, guided self-help is not readily available for this population. The current study explored the perspectives of three key stakeholder groups – children and young people with lived experience of eating disorders, parents, and healthcare professionals – on guided self-help interventions. Overall, findings suggest that guided self-help interventions are perceived as an acceptable treatment option that holds promise in providing timely access to treatment for children and young people with eating disorders. Future work must take into account these perspectives alongside the best available research evidence to optimise the use of guided self-help for this patient group.

BackgroundBehavioural and cognitive interventions remain credible approaches in addressing loneliness and depression. There was a need to rapidly generate and assimilate trial-based data during COVID-19.ObjectivesWe undertook a parallel pilot RCT of behavioural activation (a brief behavioural intervention) for depression and loneliness (Behavioural Activation in Social Isolation, the BASIL-C19 trial ISRCTN94091479). We also assimilate these data in a living systematic review (PROSPERO CRD42021298788) of cognitive and/or behavioural interventions.MethodsParticipants (≥65 years) with long-term conditions were computer randomised to behavioural activation (n=47) versus care as usual (n=49). Primary outcome was PHQ-9. Secondary outcomes included loneliness (De Jong Scale). Data from the BASIL-C19 trial were included in a metanalysis of depression and loneliness.FindingsThe 12 months adjusted mean difference for PHQ-9 was −0.70 (95% CI −2.61 to 1.20) and for loneliness was −0.39 (95% CI −1.43 to 0.65).The BASIL-C19 living systematic review (12 trials) found short-term reductions in depression (standardised mean difference (SMD)=−0.31, 95% CI −0.51 to −0.11) and loneliness (SMD=−0.48, 95% CI −0.70 to −0.27). There were few long-term trials, but there was evidence of some benefit (loneliness SMD=−0.20, 95% CI −0.40 to −0.01; depression SMD=−0.20, 95% CI −0.47 to 0.07).DiscussionWe delivered a pilot trial of a behavioural intervention targeting loneliness and depression; achieving long-term follow-up. Living meta-analysis provides strong evidence of short-term benefit for loneliness and depression for cognitive and/or behavioural approaches. A fully powered BASIL trial is underway.Clinical implicationsScalable behavioural and cognitive approaches should be considered as population-level strategies for depression and loneliness on the basis of a living systematic review.

ObjectiveThe aim of this study was to derive a research definition for ‘Long COVID (post-COVID-19 condition)’ in children and young people (CYP) to allow comparisons between research studies.DesignA three-phase online Delphi process was used, followed by a consensus meeting. Participants were presented with 49 statements in each phase and scored them from 1 to 9 based on how important they were for inclusion in the research definition of Long COVID in CYP. The consensus meeting was held to achieve representation across the stakeholder groups. Statements agreed at the consensus meeting were reviewed by participants in the Patient and Public Involvement (PPI) Research Advisory Group.SettingThe study was conducted remotely using online surveys and a virtual consensus meeting.Participants120 people with relevant expertise were divided into three panels according to their area of expertise: Service Delivery, Research (or combination of research and service delivery) and Lived Experience. The PPI Research Advisory group consisted of CYP aged 11–17 years.Main outcome measuresConsensus was defined using existing guidelines. If consensus was achieved in two or more panels or was on the border between one and two panels, those statements were discussed and voted on at the consensus meeting.ResultsTen statements were taken forward for discussion in the consensus meeting and five statements met threshold to be included in the research definition of Long COVID among CYP. The research definition, aligned to the clinical case definition of the WHO, is proposed as follows: Post-COVID-19 condition occurs in young people with a history of confirmed SARS-CoV-2 infection, with at least one persisting physical symptom for a minimum duration of 12 weeks after initial testing that cannot be explained by an alternative diagnosis. The symptoms have an impact on everyday functioning, may continue or develop after COVID infection, and may fluctuate or relapse over time. The positive COVID-19 test referred to in this definition can be a lateral flow antigen test, a PCR test or an antibody test.ConclusionsThis is the first research definition of Long COVID (post-COVID-19 condition) in CYP and complements the clinical case definition in adults proposed by the WHO.

BackgroundChildren and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.ObjectiveA non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.Methods186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital’s paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.FindingsThere was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen’s d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen’s d=0.55).ConclusionsA mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.Clinical implicationsDrop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.

ObjectiveThis study aimed to conduct a randomised pilot trial to assess the feasibility of a randomised controlled trial (RCT) to investigate the effect of telephone-guided self-help for the treatment of mental health difficulties in children with neurological conditions.DesignPreliminary RCT. The primary outcome measure was the Strengths and Difficulties Questionnaire.SettingNeurology clinics in a national tertiary paediatric hospital.PatientsYoung people attending neurology clinics who met criteria for mental health difficulties according to the Development and Wellbeing Assessment.Interventions12 weeks of telephone-guided self-help based on a modular approach to psychological therapy for children delivered to children and/or their parents (n=17; eight males; mean age 12.04 years, SD=3.34) or a waiting list for telephone-guided self-help with no additional intervention over 12 weeks (n=17; nine males; mean age 10.53 years, SD=3.14).Results124 participants completed the DAWBA, and 34 children and young people were entered into the trial. 65% of those randomised to the intervention arm completed the full intervention, and the intervention was acceptable to those completing it. However, there were significant problems related to lack of data completion (38% data loss for primary outcome measure), choice of control comparator and outcome measures. Due to significant loss of data at follow-up, the effect size findings are considered unreliable.ConclusionsFurther feasibility work should be conducted to improve data completeness before progression to a definitive trial of guided self-help for mental health problems in children with neurological conditions can be recommended.Trial registration numberISRCTN21184717.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

ObjectiveWe aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment.SettingTwo parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics.PatientsStudy 1: 406 Young people aged 7–18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3–18 attending paediatric epilepsy clinics.InterventionsParents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA).Main outcome measuresWe investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians.ResultsThe mean total difficulties score of those that had completed the SDQ fell in the ‘high’ and ‘very high’ ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.

Feeding and eating disorders can significantly impair health and psychosocial functioning. However, demand for eating disorder services is greater than services’ ability to deliver effective treatment. Low intensity psychological interventions, which are brief in nature and require less therapist input than standard treatments, have the potential to bridge this demand-capacity gap. The current review examined the effectiveness of low intensity psychological interventions for the treatment of feeding and eating disorders. Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms, particularly binge eating-related symptoms. Given their relatively low costs and ease of accessibility, such interventions can help people to access treatment at a time when this is so desperately needed. More research is needed to determine the value of low intensity psychological interventions for children and adolescents, and people with feeding and eating disorders that are not characterised by recurrent binge eating, such as anorexia nervosa, ARFID, pica and rumination disorder.

It has been repeatedly demonstrated that perfectionism can contribute to a variety of health issues. Perfectionism is a process centered on intense self-pressure to meet high standards, which has a significant impact on how an individual views themselves. Perfectionism is more prevalent in individuals with eating disorders than in those without it. There is a strong link between perfectionism and the onset of eating disorders, as well as an increase in disordered eating symptoms and a lower rate of recovery. There is currently no treatment available that addresses perfectionism in both parents and young people. The aim of the project was to work with parents and carers to co-design a parent-supported self-help program for young people that addresses perfectionism in eating disorders. We conducted three co-design workshops, followed by a four-week feasibility study to determine suitability and feedback on the intervention. The goal was to develop an intervention which can offer caregivers and young people easily available support that may aid in their understanding of perfectionism. It is hoped that by addressing perfectionism in young people with eating disorders, this approach will help them recover and thrive.

The origins of mental contamination fears are unknown although this might enhance interventions.

Mental contamination is defined and the main features of the phenomenon are set out. In addition to the familiar form of abnormal mental contamination, as evident in psychological disorders, notably Obsessive-compulsive Disorder, the phenomenon of non-clinical mental contamination is common. The clinical form is distressing, uncontrollable, constant and dysfunctional. The normal phenomenon can be disturbing but it is usually dormant, evoked intermittently, transient, tolerable, manageable, not dysfunctional and psychologically fascinating. The cognitive theory of mental contamination encompasses the causes of mental contamination, its persistence, and individual vulnerability. The field would benefit greatly from additional work, such as that reported elsewhere in this Special Issue, to incorporate the unusual manifestations of visual contamination, morphing and self-contamination, and to account for the experience of mental contamination in nonclinical and other clinical manifestations.

Mental contamination, the experience of feeling dirty in the absence of physical uncleanliness, is closely associated with obsessive compulsive disorder (OCD). Given that many features of OCD are found in other diagnoses, the primary aim of this study was to determine whether mental contamination is specific to OCD or whether it is also associated with psychopathology found in other disorders. We hypothesised that, in addition to OCD symptoms, mental contamination would be associated with other psychopathology, in particular symptoms of depression, anxiety and eating disorders, and with transdiagnostic processes such as perfectionism.

SummaryObsessive–compulsive disorder (OCD) is one of the most debilitating psychiatric conditions in young people. In DSM-5 it is no longer characterised as an anxiety disorder, but instead is part of a group of ‘obsessive–compulsive and related disorders'. In the past 10 years, cognitive—behavioural therapy (CBT) has become well established as the first-choice treatment. This article explains some of the elements of CBT and describes new directions in research which might improve interventions.

There has been a recent expansion of interest in the concept of mental contamination. Despite a growing number of experiments and interview-based studies of mental contamination, there is a need for questionnaire-based assessment measures, and for a further understanding of the degree to which mental contamination is related to other aspects of OCD symptomatology and/or to established cognitive constructs relevant to OCD. We assessed the psychometric properties of three new measures of mental contamination (the Vancouver Obsessional Compulsive Inventory—Mental Contamination Scale, the Contamination Sensitivity Scale, and the Contamination Thought-Action Fusion Scale) in participants diagnosed with OCD (n=57), participants diagnosed with an anxiety disorder other than OCD (n=24) and in undergraduate student controls (n=410). For some of these analyses, our OCD sample was subdivided into those with contamination-related symptoms and concerns (n=30) and those whose OCD excluded concerns related to contamination fear (n=27). Results showed that the three new scales had excellent psychometric properties, including internal consistency, convergent and divergent validity, and discriminant validity. Further, the new measures accounted for significant unique variance in OCD symptoms over and above that accounted for by depression, anxiety, traditional contact-based contamination, and OCD beliefs. Results are discussed in terms of the clinical utility of the scales, and of the nature of contamination fears in OCD.

Intrusive imagery is hypothesised to evoke feelings of contamination and urges to wash. This study aimed to (1) develop a questionnaire to assess imagery associated with contamination fears; and (2) compare contamination imagery in a sample of people with contamination based obsessive–compulsive disorder (C-OCD) with a non-clinical student sample.

It was recently proposed that feelings of contamination can arise in the absence of physical contact with a contaminant. Currently, there are limited data regarding this construct of ‘mental contamination’ although it is hypothesised to be relevant to obsessive–compulsive disorder (OCD) where compulsive washing in response to contamination fear is a common presentation (Rachman, 2006). This research examined the presence of mental contamination in OCD. Participants (N=177) with obsessive–compulsive symptoms completed questionnaires to assess mental contamination, OCD symptoms and thought-action fusion (TAF). Findings indicated that 46% of participants experienced mental contamination, and severity was associated with severity of OCD symptoms and TAF. Mental contamination in the absence of contact contamination was reported by 10.2% of participants. Similar findings were reported in a sub-sample of participants who had received a formal diagnosis of OCD (N=54). These findings suggest that mental contamination is a distinct construct that overlaps with, but is separate from, contact contamination, and provide preliminary empirical support for the construct.

The objectives of the study were to analyze the psychometric properties, factor structure and internal consistency of the Spanish version of the Thought-Shape Fusion Questionnaire (TSF-Q), as well as to determine its validity by evaluating the relationship of the TSF-Q to different instruments.Two groups were studied: one comprising 146 patients with a diagnosis of anorexia (n= 82), bulimia (n= 33) or unspecified eating disorder (n= 31), and another group of 115 undergraduates with no history of psychological disorder. All participants completed the TSF-Q, TAF-Q, EDI-2, STAI, BDI and SCL-90-R. Differences in TSF-Q scores between the diagnostic subgroups were also analyzed.Two factors were obtained which coincided with the two sections indicated by the authors of the questionnaire: conceptual and interpretative. The internal consistency of the TSF-Q and its subscales was determined by means of Cronbach's alpha, with values ranging between .93 and .96. The correlations with other instruments reflected adequate validity. There were no significant differences between the diagnostic subgroups.The Spanish version of the TSF-Q meets the psychometric requirements for measuring thought-shape fusion and shows adequate internal consistency and validity.

Patients with mental health difficulties do not always receive appropriate and recommended psychological treatment for their difficulties, and clinicians are not always appropriately trained to deliver them. This paper considers why this might be the case and provides an overview of the Charlie Waller Institute, a not-for-profit organisation funded by the NHS, University of Reading, and the Charlie Waller Memorial Trust. The Institute seeks to address this problem by training clinicians in wide variety of evidence-based therapies and assessing the impact of this training on clinician knowledge and skill.

The transdiagnostic approach states that there are key cognitive and behavioral processes responsible for maintaining symptoms and these are shared across psychological disorders (Harvey, Watkins, Mansell, & Shafran, 2004). The first goal of this article is to justify the potential utility of a transdiagnostic perspective for theory, research and treatment using empirical evidence and clinical vignettes. We then take as an example one set of cognitive processes——attentional processes——to illustrate the approach. Evidence for three attentional processes is provided: vigilance to external concern––related stimuli; vigilance to internal concern––related stimuli (self––focused attention) and attentional avoidance. It is concluded that each of these attentional processes are transdiagnostic. We then discuss three possible resolutions to the question: How can a transdiagnostic perspective be valid when the different psychological disorders present so differently? The three proposals are: (1) variations in idiosyncratic current concerns; (2) variations in the degree of shared processes and (3) distinct processes for specific disorders or groups of disorders. The role of a transdiagnostic approach in supporting the development and testing of theories of psychopathology is highlighted and the need for future studies that incorporate multiple patient groups is discussed.

The transdiagnostic approach to eating disorders has led to significant benefit for the research and treatment of ““eating disorder not otherwise specified”” (EDNOS). There is currently almost no research on ““anxiety disorder not otherwise specified (ADNOS).”” This case report describes a transdiagnostic approach to the treatment of ADNOS, using a modular framework. The treatment was successful in the short term but not in the longer term. It is concluded that increasing the evidence base for transdiagnostic treatment of anxiety disorders is a clinical and research priority.

A cognitive-behavioural analysis of clinical perfectionism has recently been proposed. The aim of this study was to explore the phenomenology of clinical perfectionism and its putative maintaining mechanisms. Of the 21 participants, 15 were judged to have the core psychopathology of clinical perfectionism. The data obtained were largely consistent with the model. In particular, self-imposed dysfunctional standards, continual striving and adverse consequences appeared to be highly salient features of those people who had the core psychopathology of clinical perfectionism but not of those without. A number of other possible maintaining factors not originally described in the model were also identified.

The successful treatment of extreme shape concern in patients with eating disorders has been shown to be important for their sustained recovery. This case series reports a preliminary investigation of the effects of a new brief cognitive-behavioural intervention for extreme shape concern. The intervention, which is implemented in a single 2-hour session, addresses four mechanisms hypothesized to contribute to the maintenance of extreme shape concern and is designed to be suitable as an adjunct to existing treatments for eating disorders. Participants were five women with extreme shape concern and three female patients with eating disorders. The results indicate that the intervention was effective to various degrees in each participant, and suggest that the intervention warrants further investigation. In particular, methods of increasing the potency of the intervention should be investigated, and its efficacy tested in a larger controlled study.

The aim of this case report is to describe the impact of an intervention for clinical perfectionism, derived from a new cognitive-behavioural analysis, in a patient with binge-eating disorder. It was hypothesized that clinical perfectionism was contributing to the maintenance of the eating disorder, and on this basis it was predicted that reducing clinical perfectionism would improve her eating disorder psychopathology. Standardized independent assessments were found to be consistent with this hypothesis, in that clinical perfectionism and eating disorder psychopathology improved over an eight-session intervention and improvements were largely maintained at 5-month follow-up.