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Background: No previous studies have reported predictors and moderators of outcome of psychological therapies for depression experienced by adults with intellectual disabilities (IDs). We investigated baseline variables as outcome predictors and moderators based on a randomised controlled trial where behavioural activation was compared with guided self‐help. Methods: This study was an exploratory secondary data analysis of data collected during a randomised clinical trial. Participants (n = 161) were randomised to behavioural activation or guided self‐help and followed up for 12 months. Pre‐treatment variables were included if they have previously been shown to be associated with an increased risk of having depression in adults with IDs or have been reported as a potential predictor or moderator of outcome of treatment for depression with psychological therapies. The primary outcome measure, the Glasgow Depression Scale for Adults with Learning Disabilities (GDS‐LD), was used as the dependant variable in mixed effects regression analyses testing for predictors and moderators of outcome, with baseline GDS‐LD, treatment group, study centre and antidepressant use as fixed effects, and therapist as a random effect. Results: Higher baseline anxiety (mean difference in outcome associated with a 1 point increase in anxiety 0.164, 95% confidence interval [CI] 0.031, 0.297; P = 0.016), lower performance intelligence quotient (IQ) (mean difference in outcome associated with a 1 point increase in IQ 0.145, 95% CI 0.009, 0.280; P = 0.037) and hearing impairment (mean difference 3.449, 95% CI 0.466, 6.432; P = 0.024) were predictors of poorer outcomes, whilst greater severity of depressive symptoms at baseline (mean difference in outcome associated with 1 point increase in depression −0.160, 95% CI −0.806, −0.414; P < 0.001), higher expectation of change (mean difference in outcome associated with a 1 point increase in expectation of change −1.013, 95% CI −1.711, −0.314; p 0.005

Background: No previous studies have reported predictors and moderators of outcome of psychological therapies for depression experienced by adults with intellectual disabilities (IDs). We investigated baseline variables as outcome predictors and moderators based on a randomised controlled trial where behavioural activation was compared with guided self-help. Methods: This study was an exploratory secondary data analysis of data collected during a randomised clinical trial. Participants (n = 161) were randomised to behavioural activation or guided self-help and followed up for 12 months. Pre-treatment variables were included if they have previously been shown to be associated with an increased risk of having depression in adults with IDs or have been reported as a potential predictor or moderator of outcome of treatment for depression with psychological therapies. The primary outcome measure, the Glasgow Depression Scale for Adults with Learning Disabilities (GDS-LD), was used as the dependant variable in mixed effects regression analyses testing for predictors and moderators of outcome, with baseline GDS-LD, treatment group, study centre and antidepressant use as fixed effects, and therapist as a random effect. Results: Higher baseline anxiety (mean difference in outcome associated with a 1 point increase in anxiety 0.164, 95% confidence interval [CI] 0.031, 0.297; P = 0.016), lower performance intelligence quotient (IQ) (mean difference in outcome associated with a 1 point increase in IQ 0.145, 95% CI 0.009, 0.280; P = 0.037) and hearing impairment (mean difference 3.449, 95% CI 0.466, 6.432; P = 0.024) were predictors of poorer outcomes, whilst greater severity of depressive symptoms at baseline (mean difference in outcome associated with 1 point increase in depression −0.160, 95% CI −0.806, −0.414; P < 0.001), higher expectation of change (mean difference in outcome associated with a 1 point increase in expectation of change −1.013, 95% CI −1.711, −0.314; p 0.005

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: No studies have explored the acceptability of Behavioural Activation and Guided Self-Help interventions for depression with people who have intellectual disabilities. METHOD(S): Twenty-five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self-Help intervention. A framework analysis was used to analyse interviews covering participants' expectations and views of therapy. RESULT(S): Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time-limited nature of the interventions and a wish for longer-term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. CONCLUSION(S): The participants reported having positive engagement with the therapies but expressed a wish for longer-term supportive relationships.Copyright © 2019 John Wiley & Sons Ltd.

Adequate vegetable consumption is fundamental to a healthy, balanced diet; however, global compliance with recommendations to increase consumption is poor. There is a growing interest in the sustainability of current dietary patterns in light of expected climate change and an expanding global population where part of the response is increasing vegetable intake. Two international projects, VeggiEAT and Veg+, explored the determinants of vegetable liking and consumption in different age groups and countries and the effect of a nudging strategy on vegetable consumption in an out-of-home setting. The projects found that the importance given by consumers to natural or healthy ingredients, social norms, female gender and positive attitudes towards nudging all influenced vegetable consumption. Some sensory factors, such as bitterness and sourness, had a negative loading, while others, such as sweetness, had a positive effect on liking for vegetables. ‘Dish of the day’, as a nudging strategy in a workplace canteen setting, increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people. Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve their availability and uptake, especially within out-of-home foodservice.

Adequate vegetable consumption is fundamental to a healthy, balanced diet; however, global compliance with recommendations to increase consumption is poor. There is a growing interest in the sustainability of current dietary patterns in light of expected climate change and an expanding global population where part of the response is increasing vegetable intake. Two international projects, VeggiEAT and Veg+, explored the determinants of vegetable liking and consumption in different age groups and countries and the effect of a nudging strategy on vegetable consumption in an out-of-home setting. The projects found that the importance given by consumers to natural or healthy ingredients, social norms, female gender and positive attitudes towards nudging all influenced vegetable consumption. Some sensory factors, such as bitterness and sourness, had a negative loading, while others, such as sweetness, had a positive effect on liking for vegetables. ‘Dish of the day’, as a nudging strategy in a workplace canteen setting, increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people. Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve their availability and uptake, especially within out-of-home foodservice.

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(S): 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. RESULT(S): 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. CONCLUSION(S): The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.Copyright © 2018 John Wiley & Sons Ltd.

Background: No studies have explored the acceptability of Behavioural Activation and Guided Self-Help interventions for depression with people who have intellectual disabilities. Method: Twenty-five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self-Help intervention. A framework analysis was used to analyse interviews covering participants’ expectations and views of therapy. Results: Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time-limited nature of the interventions and a wish for longer-term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. Conclusions: The participants reported having positive engagement with the therapies but expressed a wish for longer-term supportive relationships.

Background: No studies have explored the acceptability of Behavioural Activation and Guided Self-Help interventions for depression with people who have intellectual disabilities. Method: Twenty-five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self-Help intervention. A framework analysis was used to analyse interviews covering participants’ expectations and views of therapy. Results: Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time-limited nature of the interventions and a wish for longer-term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. Conclusions: The participants reported having positive engagement with the therapies but expressed a wish for longer-term supportive relationships.

Compared to meals prepared at home, meals eaten out of home tend to contain more energy, total fat and saturated fat and it is here where consumers can have very little knowledge of the nutrient profile of the dish they are eating. The aim of the European Union-funded FoodSMART project (www.foodsmartproject.net) was to develop an innovative technical menu solution ‘app’ that enables informed consumer food choice, which takes into account individual preferences (such as dietary requirements) as well as food product specifications, in a workplace canteen setting. A best–worst scaling questionnaire was conducted to identify consumers’ functional app requirements and inform the development of personalised food choice messages. Proof of concept was tested using the System Usability Scale in consumers from four European countries (Denmark, France, Greece and the UK). Information on ingredients, nutrition, food ‘naturalness’ and value for money were those most valued by consumers, with this presented ideally in a personalised way and using a traffic light model. Field trials of the FoodSMART app indicated that consumers found it to be simple, easy to use and attractive for frequent use. By gaining insight into the needs of consumers, dietary information can be better tailored and provided in an appropriate format to enable informed food choice.

Vegetable consumption in adolescents is reported to be low, at least in part, due to the unappealing sensory properties of vegetables, such as bitter tastes. However, not all vegetables have unappealing sensory properties, and strategies to improve vegetable consumption may benefit from wider consideration. This work aimed to understand the individual characteristics in adolescents from four European countries associated with the regular consumption and liking of vegetables with more appealing and less appealing sensory properties. Adolescents from Denmark (N = 178), the UK (N = 155), France (N = 206) and Italy (N = 197) completed self-report questionnaires to assess all variables. We found higher self-reported consumption and liking of vegetables with more appealing than less appealing sensory properties. Regular consumption of both types of vegetable was associated with healthier eating habits and a higher liking for each vegetable type. Liking for vegetables with more appealing sensory properties was higher in individuals with lower food neophobia, healthier eating habits, higher interest in consuming foods for sensory reasons and higher liking for vegetables with less appealing properties. Liking for vegetables with less appealing sensory properties was higher in individuals with lower food neophobia, higher concern for the consumption of natural foods, and higher liking for vegetables with more appealing properties. Some gender and country-specific differences were also found. Our findings suggest that strategies to increase vegetable consumption in adolescents should focus on increasing healthy eating in general, increasing vegetable liking, and may benefit from reducing food neophobia and enhancing the positive sensory and natural aspects of vegetables.

Background: Depression is the most prevalent mental health problem among people with learning disabilities. Objective(s): 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(s): 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(s): Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. Participant(s): 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. Intervention(s): 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 Measure(s): 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. Result(s): 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 Ste

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