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Background Known risk alleles for epithelial ovarian cancer (EOC) account for approximately 40% of the heritability for EOC. Copy number variants (CNVs) have not been investigated as EOC risk alleles in a large population cohort. Methods Single nucleotide polymorphism array data from 13 071 EOC cases and 17 306 controls of White European ancestry were used to identify CNVs associated with EOC risk using a rare admixture maximum likelihood test for gene burden and a by-probe ratio test. We performed enrichment analysis of CNVs at known EOC risk loci and functional biofeatures in ovarian cancer–related cell types. Results We identified statistically significant risk associations with CNVs at known EOC risk genes; BRCA1 (PEOC = 1.60E-21; OREOC = 8.24), RAD51C (Phigh-grade serous ovarian cancer [HGSOC] = 5.5E-4; odds ratio [OR]HGSOC = 5.74 del), and BRCA2 (PHGSOC = 7.0E-4; ORHGSOC = 3.31 deletion). Four suggestive associations (P Conclusions CNVs in BRCA1 have been previously reported in smaller studies, but their observed frequency in this large population-based cohort, along with the CNVs observed at BRCA2 and RAD51C gene loci in EOC cases, suggests that these CNVs are potentially pathogenic and may contribute to the spectrum of disease-causing mutations in these genes. CNVs are likely to occur in a wider set of susceptibility regions, with potential implications for clinical genetic testing and disease prevention.

Purpose It is unclear how hospitals are responding to the mental health needs of the population in England, against a backdrop of diminishing resources. We aimed to document patterns in hospital activity by psychiatric disorder and how these have changed over the last 22 years. Methods In this observational time series analysis, we used routinely collected data on all NHS hospitals in England from 1998/99 to 2019/20. Trends in hospital admissions and bed days for psychiatric disorders were smoothed using negative binomial regression models with year as the exposure and rates (per 1000 person-years) as the outcome. When linear trends were not appropriate, we fitted segmented negative binomial regression models with one change-point. We stratified by gender and age group [children (0–14 years); adults (15 years +)]. Results Hospital admission rates and bed days for all psychiatric disorders decreased by 28.4 and 38.3%, respectively. Trends were not uniform across psychiatric disorders or age groups. Admission rates mainly decreased over time, except for anxiety and eating disorders which doubled over the 22-year period, significantly increasing by 2.9% (AAPC = 2.88; 95% CI: 2.61–3.16; p p Conclusion In the last 22 years, there have been overall reductions in hospital activity for psychiatric disorders. However, some disorders showed pronounced increases, pointing to areas of growing need for inpatient psychiatric care, especially among children.

Background: Adolescent cancer survivors are a particularly vulnerable group of young patients. Compared with healthy peers, adolescent survivors face more psychosocial difficulties and are at increased risk of developing psychiatric disorders. Aims: We aimed to establish prevalence rates and predictors of psychiatric disorders in young cancer survivors and discuss areas for targeted interventions. Method: We systematically reviewed four major online databases: Embase, PsychINFO, Scopus, and Medline for quantitative studies evaluating mental health in adolescent cancer survivors. We used a narrative synthesis approach. Results: Nineteen studies met our inclusion criteria. Across the sample, up to 34% met criteria for post‐traumatic stress disorder (PTSD), 13% for clinical depression, and 8% for anxiety. Maladaptive coping, illness relapse, higher number of late effects, brain tumor diagnosis, and poor family functioning and parental distress were associated with higher psychological distress. Conclusions: A significant subset of adolescent survivors reports PTSD, anxiety, and depression symptoms. Individuals who present with more vulnerabilities and higher risk indices should be routinely assessed in order to reduce the psychological, social, and economic burden associated with poor mental health in this population. Early prevention strategies should target maladaptive coping mechanisms and promote healthy peer relationships and family functioning.

The hypothesis that the S allele of the 5-HTTLPR serotonin transporter promoter region is associated with increased risk of depression, but only in individuals exposed to stressful situations, has generated much interest, research and controversy since first proposed in 2003. Multiple meta-Analyses combining results from heterogeneous analyses have not settled the issue. To determine the magnitude of the interaction and the conditions under which it might be observed, we performed new analyses on 31 data sets containing 38 802 European ancestry subjects genotyped for 5-HTTLPR and assessed for depression and childhood maltreatment or other stressful life events, and meta-Analysed the results. Analyses targeted two stressors (narrow, broad) and two depression outcomes (current, lifetime). All groups that published on this topic prior to the initiation of our study and met the assessment and sample size criteria were invited to participate. Additional groups, identified by consortium members or self-identified in response to our protocol (published prior to the start of analysis) with qualifying unpublished data, were also invited to participate. A uniform data analysis script implementing the protocol was executed by each of the consortium members. Our findings do not support the interaction hypothesis. We found no subgroups or variable definitions for which an interaction between stress and 5-HTTLPR genotype was statistically significant. In contrast, our findings for the main effects of life stressors (strong risk factor) and 5-HTTLPR genotype (no impact on risk) are strikingly consistent across our contributing studies, the original study reporting the interaction and subsequent meta-Analyses. Our conclusion is that if an interaction exists in which the S allele of 5-HTTLPR increases risk of depression only in stressed individuals, then it is not broadly generalisable, but must be of modest effect size and only observable in limited situations. © 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.

BACKGROUND: Cognitive theories of depression suggest that beliefs of low self-worth and the tendency to attribute negative events to causes that are global (widespread rather than specific) and stable (will persist rather than change in the future) are associated with the development of depressed mood. Such theories are supported by evidence from prospective studies and have guided the development of successful treatment and prevention strategies such as CBT. However, the relative importance of different psychological constructs within cognitive theories is unknown. This is important to refine cognitive theories and develop more efficient prevention strategies.METHOD: We used prospective data from over 3500 young adults from the Avon Longitudinal Study for Parents and Children (ALSPAC) cohort in the UK to investigate the association between cognitive style, measured by short forms of the Dysfunctional Attitudes Scale (DAS) and Cognitive Styles Questionnaire-Short Form (CSQ-SF) at age 18, and future depressed mood at age 19. Structural equation modelling techniques were used to separate cognitive style constructs.RESULTS: Cognitive styles were associated with future depressed mood, independently of baseline mood, both as measured by the DAS-SF and the CSQ-SF. Of the different CSQ-SF constructs, only global attributions were associated with both baseline and future mood independently of other constructs.LIMITATIONS: The study was subject to attrition and the follow-up was relatively short (10 months).CONCLUSION: The findings suggest that the tendency to attribute negative events specifically to global causes could be particularly important for depression. Reducing global attributions is potentially important in the prevention and treatment of depression.

Supportive relationships are key to a healthy, long, and fulfilled life (Umberson & Karas Montez, 2010). While much is known about the general structure of our personal relationships (i.e., ego networks; Sutcliffe et al., 2012) and self-bounded communities (i.e., complete or cohort networks; Zhou et al., 2005), we still know relatively little about how these social networks adapt to critical life events, such as the transition of entering university (Wrzus et al., 2013). This thesis investigates the effects of this first major transition on young adults’ personal relationships, social integration, and mental health. In Chapter 1, I introduce the theoretical and empirical background underlying my research and present my unique prospective, longitudinal social network design in which students of two consecutive cohorts at a College of Oxford University participated (five assessments, across 2.5 years in Study 1, N = 90; and seven, across 1.5 years in Study 2, N = 81). In Chapter 2, I examine how these students manage their personal relationships and find that ego networks are overall remarkably robust and grow uniformly within just the first two months at university. In Chapter 3, I investigate how students socially integrate into their new social environment and find that cohort networks driven by homophily factors form rapidly and stabilise just as quickly. In Chapter 4, I study the mental health trajectories of these young adults and find uncommonly high levels of anxiety and depression that temporarily or gradually worsen during the transition. Finally, in Chapter 5, I discuss the main findings and outline their theoretical, methodological, and practical implications. Overall, this thesis shows that the impact of the transition to university on students’ social relationships and mental health occurs rapidly. Future research might focus on the first few weeks of this transition in more detail and differentiate students’ individual experiences further.

This project uses mixed methods to investigate cognitive and behavioural factors associated with social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD) symptoms among young people who have been bullied. The aim is to explore the social trauma of bullying, investigate factors that increase vulnerability to ongoing emotional distress, and develop bespoke measures that are clinically useful and statistically robust. Following a general introduction in Chapter 1, this thesis is structured into two main sections. In the first section, I present four studies exploring and evaluating factors associated with adjustment after bullying. In Chapter 2, longitudinal analysis of a large prospective cohort study shows that children who were severely bullied and have an external locus of control are more likely to experience a steeper increase in social fear during early adolescence compared to those with an internal locus of control. The following chapters describe development and validation of measures of bullying-related cognitions and coping strategies associated with PTSD and social anxiety among young adults. Chapter 3 reports pilot data on cognitive themes related to bullying that are associated with SAD and PTSD symptoms and suggests the online survey format is acceptable. In Chapter 4, qualitative analyses of semi-structured interviews with young adults about their experiences of bullying and their past and ongoing reactions suggest additional themes that may be associated with higher ongoing symptoms. Chapter 5, the last in this section, draws these findings together and describes statistical evaluation of new measures of cognitions and behaviours related to bullying which were derived from the previous studies. Data is from an online survey study with over a thousand young people starting university or college in the UK. The newly developed measures were reliable and valid, defined as the Bullied Cognitions Inventory, Bullied Social Attitudes Inventory, and the Bullied Social Behaviours Scale. In the second section, associations of the new cognitive and behavioural measures with SAD and PTSD are tested. Chapter 6 reports the extent to which these measures distinguish between SAD, PTSD, or no likely clinical diagnosis in the online survey data. Participants in this study were invited to complete three additional surveys during their first year of university and, in Chapter 7, longitudinal analyses are reported that explore changes in PTSD and SAD symptoms and the extent to which the new measures can predict differing outcomes. Together, these studies highlight the social trauma of bullying and identify cognitive and behavioural factors associated with SAD and PTSD symptoms among young adults who have been bullied. Psychometrically validated scales suggest themes that distinguish between symptoms as well as transdiagnostic features. Results and limitations are discussed, as well as suggestions for clinical application and future research.

A wealth of research examining intergroup contact theory (Allport, 1954; Brown & Hewstone, 2005) has shown that outgroup contact improves outgroup attitudes. Few studies have examined the corresponding role of ingroup contact, despite its prevalence and evidence suggesting it may detrimentally affect intergroup relations (e.g., Levin et al., 2003; Wilder & Thompson, 1980), or the corresponding effects on ingroup attitudes. This thesis addresses these lacunae by investigating the ways in which ingroup contact, in addition to outgroup contact, shapes both ingroup and outgroup attitudes. In so doing, this thesis aims to achieve a more comprehensive understanding of how contact influences intergroup relations through the incorporation of ingroup contact in intergroup contact theory. Chapter 1 details the theoretical and empirical rationale that underpins this thesis, introduces the 10 studies (total N = 34,944) comprising this thesis, and outlines the analysis techniques used to test the proposed hypotheses (i.e., latent growth modelling, meta-analysis, random-intercept cross lagged panel modelling, and longitudinal social network analysis). Chapter 2 examines the relationship between ingroup and outgroup contact and finds that, at least for friendships, more ingroup contact is associated with less outgroup contact, and vice versa. Chapter 3 investigates the effects of contact on attitudes and identifies positive between-person associations for ingroup contact and ingroup attitudes, and for outgroup contact and outgroup attitudes, yet obtains little evidence for the corresponding within-person effects. Chapter 4 explores the socialisation of ingroup and outgroup attitudes and reports that individuals’ attitudes are influenced by the attitudes held by their ingroup, but not their outgroup, friends. Finally, Chapter 5 discusses the research presented in this thesis and outlines its theoretical, methodological and practical implications. Overall, this thesis shows that ingroup contact has an important role in shaping both ingroup and outgroup attitudes, which highlights the imperative need for further research in this nascent area of study.

Social anxiety disorder is a common anxiety disorder that can markedly interfere with life and is particularly persistent in the absence of treatment. Outcomes for the treatment of adults with social anxiety disorder have improved considerably in the last twenty years, particularly due to the development of psychological therapies designed to target specific cognitive and behavioural processes that maintain the disorder. Internet versions of the therapies that have been developed also hold the promise of being able to greatly increase the availability of effective therapy in adults. The overarching aim of the thesis is to improve our understanding of the cognitive and behavioural maintenance mechanisms of adolescent social anxiety and to develop an effective and scalable intervention for the disorder in youth. My first study is a systematic review of empirical research examining the Clark & Wells (1995) cognitive model of social anxiety in adolescents. My second and third studies adopt experimental methods to test key hypotheses of the model in adolescents. The fourth and fifth studies are concerned with improving measurement of social anxiety symptoms and related cognitions to aid research and clinical activities. The sixth and final study is a randomised waitlist-controlled trial of internet-delivered cognitive therapy for social anxiety disorder in adolescents. Adopting a strategy of closely interweaving clinical and experimental studies, the thesis provides support for: (1) the applicability of the cognitive model of Clark & Wells (1995) to adolescents; (2) self-report measures of social anxiety symptoms and related cognitions; and (3) internet-delivered cognitive therapy for the treatment of adolescent social anxiety disorder.

My thesis examines what drives student outcomes and student satisfaction in online schooling. Specifically, I examine whether psychometric matching between students and tutors can be used to enhance outcomes or satisfaction and in light of this, the key considerations for governments seeking to regulate the online schooling landscape. Two systematic literature reviews are conducted: firstly, what drives student outcomes and student satisfaction in online schooling and secondly (Chapter Two), the use of algorithmic matching between students and educators in schooling to improve student outcomes and/or student satisfaction (Chapter Three). I perform a qualitative analysis of leading virtual high schools, interviewing 21 students using NVivo qualitative analysis software (Chapter Four). I conduct cross-sectional analysis on a data-set from Crimson Education, an online education company, to evaluate the impact of psychometric characteristics on student satisfaction (Chapter Five). I run a randomized control trial to test the causality of a psychometric matching algorithm on student outcomes and student satisfaction (Chapter Six). My randomized control trial analysis finds that psychometric matching can lead to significant impact on writing scores and on student satisfaction within Western Europe and Latin America. My cross-sectional analysis also finds that student satisfaction scores can be impacted by the psychometric characteristics of students. Finally, I provide a set of recommendations for public policy makers looking to adapt legislation to the emerging online high schooling sector in light of my findings from earlier chapters, in particular my qualitative analysis and systematic reviews (Chapter Seven).

Art is a powerful form of communication between artists and audiences. In this thesis, I will explore two questions that emerge from the literature on art as a means of communication and connection between artist and audience: 1) how can technology be used to augment the sense of psychological connection between the audience and artist? and 2) why do we like sad art? To answer the first question, Chapters 2 and 3 present experimental data showing that listening to music while wearing haptic devices (versus no haptics) and headphones (versus speakers) increases empathy, parasocial bond, and loyalty towards the artist and also decreases feelings of loneliness in the listener. Results indicate that feelings of social presence mediate the relationship between these immersive technologies and these measures of psychological connection to the artist. To answer the second question, Chapter 4 presents data from five experiments. Studies 1 and 2 show that framing a text as art versus not-art increases liking for the negative emotions expressed in it. Study 3 showed that there was an effect of art/not-art on liking even after controlling for differences in perceived fictionality between art/not-art. Study 4 found that appropriation mediates the effect of art/not-art on liking and, thus, explains liking for sad art. Study 5 controlled for a possible confound in the study design and found that the results replicated. Together, this thesis explores art as a means of communication and connection by providing new insights on the use of technology to enhance connection with artists and by finding empirical evidence to support the philosophical debate on the enjoyment of sad art. These studies shed light on the ways in which art can be used to connect with others and also connect with ourselves and our own emotions.