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Background Evidence from the UK from the early stages of the covid-19 pandemic showed that people with Intellectual Disabilities (ID) had higher rates of covid-19 mortality than people without ID. However, estimates of the magnitude of risk vary widely; different studies used different time periods; and only early stages of the pandemic have been analysed. Existing analyses of risk factors have also been limited. The objective of this study was to investigate covid-19 mortality rates, hospitalisation rates, and risk factors in people with ID in England up to the end of 2021. Methods Retrospective cohort study of all people with a laboratory-confirmed SARS-CoV-2 infection or death involving covid-19. Datasets covering primary care, secondary care, covid-19 tests and vaccinations, prescriptions, and deaths were linked at individual level. Results Covid-19 carries a disproportionately higher risk of death for people with ID, above their already higher risk of dying from other causes, in comparison to those without ID. Around 2,000 people with ID had a death involving covid-19 in England up to the end of 2021; approximately 1 in 180. The covid-19 standardized mortality ratio was 5.6 [95% CI 5.4, 5.9]. People with ID were also more likely to be hospitalised for covid-19 than people without ID. The main determinants of severe covid-19 outcomes (deaths and/or hospitalisations) in both populations were age, multimorbidity and vaccination status. The key factor responsible for the higher risk of severe covid-19 in the ID population was a much higher prevalence of multimorbidity in this population. AstraZeneca vaccine was slightly less effective in preventing severe covid-19 outcomes among people with ID than among people without ID. Conclusions People with ID should be considered a priority group in future pandemics, such as shielding and vaccinations.

Background The minimal clinically important difference (MCID) is relevant in the estimation of improvement in a patient outcome. Aim To determine the MCID on the Aberrant Behaviour Checklist–Irritability (ABC-I), widely used to measure the effects of intervention for aggressive challenging behaviour in people with intellectual disabilities. Method and procedures We utilised distribution and anchor based methods to estimate the ABC-I MCID. We extracted data from 15 randomised controlled trials (RCTs) for meta-analysis. We conducted three online workshops with family carers and professionals to consider meaningful change in case vignettes of increasing severity of aggressive challenging behaviour. Outcomes and results We did not find overlap in the range of values between the two approaches. The meta-analysis indicated a range of MCID on the ABC-I (0.05, 4.94) whilst the anchor-based estimation indicated a larger change (6.6, 16.6). Conclusions and implications The MCID is essential in interpreting the results from intervention studies. The present work was undertaken as part of a wider programme on the development and testing of a psychosocial intervention for aggressive challenging behaviour, and it is of interest to researchers in justifying how they choose and determine the MCID on the outcome of interest.

Background: Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. Method: Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. Results: The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. Conclusions: The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.

BACKGROUND: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

BACKGROUND: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

BACKGROUND: Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE: The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN: A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING: Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS: Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS: BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES: The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS: There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points)

BACKGROUND: Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE: The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN: A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING: Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS: Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS: BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES: The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS: There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points)

Supporting positive change in lifestyle behaviours is a priority in tackling the health inequalities experienced by adults with intellectual disabilities. In this systematic review, we examine the evidence on the definition, measurement and epidemiology of sedentary behaviour of adults with intellectual disabilities. A systematic literature search of PUBMED, EMBASE, MEDLINE and Google Scholar was performed to identify studies published from 1990 up to October 2015. Nineteen papers met the criteria for inclusion in the systematic review. Many researchers do not distinguish between insufficient physical activity and sedentary behaviour. None of the studies reported the reliability and validity of the methods used to measure sedentary behaviour. Sedentary time, assessed objectively, ranged from 522 to 643 min/day: higher than in adults without intellectual disabilities. This first-ever review of sedentary behaviour and intellectual disabilities found that at present the evidence base is weak. Studies calibrating accelerometer data with criterion measures for sedentary behaviour are needed to determine specific cut-off points to measure sedentary behaviour in adults with intellectual disabilities. Researchers should also examine the reliability and validity of using proxy-report questionnaires to measure sedentary behaviour in this group. A better understanding of sedentary behaviour will inform the design of novel interventions to change lifestyle behaviours of adults with intellectual disabilities.

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI –2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change –4·2 GDS-LD points [95% CI –6·0 to –2·4], p<0·0001; StepUp, mean change –4·5 GDS-LD points [–6·2 to –2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants’ total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our know

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI –2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change –4·2 GDS-LD points [95% CI –6·0 to –2·4], p<0·0001; StepUp, mean change –4·5 GDS-LD points [–6·2 to –2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants’ total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our know

BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depr

BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depr

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of sev

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of sev

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of sev

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of sev

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of sev