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Background Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child’s emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised ‘Partners in Parenting’ programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting. Methods In total, 433 family dyads (parents/carers and children aged 11–15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent’s depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained. Discussion Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised ‘Partners in Parenting’ programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. Trial registration {2a} ISRCTN63358736. Registered 18 September 2019.

Objective\ud \ud Self‐harm remains a serious public health concern; however, identifying adolescents at risk is challenging. While self‐harm has been linked with difficulties in emotional regulation postinjury, comparatively little is known about how such difficulties may impact on the future development of self‐harm behavior.\ud \ud Methods\ud \ud A total of 318 pupils aged 14–15 years completed measures on history of direct self‐injurious behavior (D‐SIB), emotional regulation, depression, and anxiety at two time points across a six‐month period.\ud \ud Results\ud \ud Of 13% (42) of participants reported their first episode of D‐SIB over the six‐month period and reported increased difficulties with emotional regulation prior to initial D‐SIB. Regression analyses found significant associations for emotional regulation and specifically lack of emotional clarity prior to first episode of D‐SIB. Lack of emotional awareness and difficulties with impulse control was significantly associated in those with ongoing D‐SIB.\ud \ud Conclusions\ud \ud Prior to first episode of D‐SIB, young people may experience difficulty regulating emotions, a difficulty which appears less pronounced following their engagement with D‐SIB. Our findings implicate difficulties in the early evaluation and understanding of emotions which may later impair attempts at emotion modulation and increase risk of D‐SIB. Such findings might help inform early identification of adolescents at risk of initial D‐SIB.

Objective To explore lay understanding and perceptions of schizophrenia in university students. Design Qualitative study using semi-structured interviews and thematic analysis. Setting The University of Birmingham, West Midlands. Participants 20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1). Results Findings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause. Conclusions The university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of ‘bulimia.’ It thereby offers an alternative portrait of relationships between eating disorders and ‘culture,’ one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment.\ud \ud

The introduction of female writers to The Archers in 1975 brought a new perspective to the programme, revitalising its profile and cementing its place in the British psyche. This ‘feminisation’ of the programme was an important turning point for the women of Ambridge with increasing focus on issues important to them. This chapter argues that until this time storylines had tended to position women in the background of farming life, their identities shaped solely in terms of their relationships with the men of the village, as homemakers, carers and love-interests. The new band of female writers meant that the women of Ambridge were able to emerge as fully-rounded characters in their own right, as professionals, farmers, business women and matriarchs, at the forefront of village life. It goes on to discuss the character and function of Susan Carter, from the writer's perspective of both a research psychologist and the actor who plays Susan. It is argued that Susan utilises gossip not only as a tool with which to create interpersonal alliances and cement friendships but also to enhance her damaged self-worth and increase her status and power as a fount of all Ambridge knowledge.

Background Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors. Aims This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15–24 years. Method This study used a matched case–control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse. Results Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15–18 years, work stress in women aged 19–24 years. Conclusion Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care.

AIM: This study explores the mental health needs of teachers and how these might impact on their capacity to provide early identification and intervention strategies to support their student's emotional well-being. METHOD: The present study surveyed a sample of UK teachers (N = 320) to explore the impact of work-related stress on their mental health and their ability to provide early intervention support for their students. RESULTS: Our survey showed high levels of work-related stress due to time pressures and excessive workloads; many teachers failed to seek help for their stress often due to stigmatic attitudes and fear of negative response by senior management. Such factors led some to withdraw from taking on extra responsibilities with regard to student support and to consider leaving the teaching profession altogether. Coping mechanisms included the use of alcohol and tobacco, with only a small minority receiving access to psychological therapies. CONCLUSION: High levels of work-related stress in teachers can have serious consequences for their mental health and impede their ability to provide effective early intervention support for their student's emotional well-being. Improvements in mental health training for teachers and greater assistance for their own mental health needs are necessary. Language: en

Recent policy guidelines highlight the importance of increasing the identification of young people at risk of developing mental health problems in order to prevent their transition to longer-term problems, avoid crisis and remove the need for care through specialist mental health services or hospitalisation. Early awareness of the often insidious behavioural and cognitive changes associated with deteriorating mental wellbeing, however, is difficult, but it is vital if young people, their families and those who work with them are to be fully equipped with the skills to aid early help seeking. \ud Our early intervention research continues to highlight the necessity of engaging with and listening to the voices of young people, families, and those who work with children and young people, not only in developing greater understanding of why some young people may be more be at-risk in terms of their mental health, but to provide children and young people with the best mental health support we can. \ud Collaborative working with young people, their families and those who work with them has been an essential dimension of our youth mental health research in Birmingham, UK, enabling us to listen to the personal narratives of those with lived experience and to work alongside them. This paper highlights some of our key studies and how we have endeavored to make intra-agency working successful at each stage of the research process through increasing use of digital and youth informed resources to engage young people; a methodology which continues to inform, guide and develop our early intervention research and implementation.\ud

Aim: Delayed help‐seeking can have serious consequences for young people with first‐episode psychosis (FEP), in terms of treatment response and outcome. Young people's narratives about help‐seeking are important to understand why delays occur; however, as the majority of help‐seeking is initiated by family members, through a general practitioner (GP), family narratives are also of interest. The aim of this study was to explore help‐seeking for FEP, including first contact with a GP. Method: A semistructured interview was developed using a topic guide. Framework analysis was used to analyse data and a deductive qualitative method for applied research. The study was set in Birmingham, UK. Participants were interviewed separately by researchers. Joint coding and identification of 14 complete family dyads was then explored for emerging patterns within the family context. Results: Family responses to FEP that had an impact on help‐seeking behaviour included withdrawal, normalization, stigma, fear and guilt; poor knowledge of availability, and means of access to mental health services was also important. Help‐seeking was usually instigated by a family member through a GP, although this was not the case for two of our families, and while contact with GP was generally described as a positive experience for several families, it was hindered by poor communication and lack of engagement. Conclusion: Families play a key role in facilitating help‐seeking for FEP, but attempts are often derailed by complex family responses to illness. Public mental health interventions should focus on increasing community awareness of psychosis and improving access and alternative routes to mental health services. However, improvements will have little impact unless primary care and other help‐seeking sources engage in open and easy dialogue with the families and young people trying to access their specialist services.

Background No evidence based approach to reduce duration of untreated psychosis (DUP) has been effective in the UK. Existing interventions have many components and have been difficult to replicate. The majority of DUP in Birmingham, UK is accounted for by delays within mental health services (MHS) followed by help-seeking delay and, we hypothesise, these require explicit targeting. This study examined the feasibility and impact of an intervention to reduce DUP, targeting help-seeking and MHSs delays. Methods A dual-component intervention, comprising a direct care pathway, for 16-25 year olds, and a community psychosis awareness campaign, using our youth-friendly website as the central hub, was implemented, targeting the primary sources of care pathway delays experienced by those with long DUP. Evaluation, using a quasi-experimental, design compared DUP of cases in two areas of the city receiving early detection vs detection as usual, controlling for baseline DUP in each area. Results DUP in the intervention area was reduced from a median 71 days (mean 285) to 39 days (mean 104) following the intervention, with no change in the control area. Relative risk for the reduction in DUP was 0.74 (95 % CI 0.35 to 0.89; p = .004). Delays in MHSs and help-seeking were also reduced. Conclusions Our targeted approach appears to be successful in reducing DUP and could provide a generalizable methodology applicable in a variety of healthcare contexts with differing sources of delay. More research is needed, however, to establish whether our approach is truly effective. Trial registration ISRCTN45058713 - 30 December 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-0816-7) contains supplementary material, which is available to authorized users.

Objective: To examine whether abuse and dysfunctional parental affiliation in childhood are associated with voice appraisals of power and perceived expressed emotion, present-day shame cognitions, and depression and suicidal ideation. Method: Seventy-four voice-hearers participated. Depressive and suicidal status, childhood abuse and parental affiliation, shame cognitions and appraisals of voice power and perceived expressed emotion were assessed. Results: Overall, childhood emotional abuse was linked to greater voice power and lack of emotional support from parents was linked to lower support and affiliation with voices. Rejection from father and emotional abuse were the strongest and consistent predictors of internal and external shame cognitions. Depression was strongly correlated with parental emotional abuse. Conclusion: Our findings suggest that the voice/voice-hearer relationship operates as an emotional mirror reflecting elements of traumatic childhood affiliations, and that these affiliations are...

IntroductionFamily dysfunction can test the resilience of adolescents, specifically those from single parent families and those attending schools in more socio-economically challenged areas.ObjectivesTo determine what factors are associated with resilience for those from single parent families or attend schools in more socio-economically challenged areas.AimsTo examine the role of emotional regulation and self-esteem as putative resilience factors in the context of single parents status and socioeconomic disadvantage.MethodsSecondary school pupils from single and dual parent families aged 13 to 15 answered questionnaires at three time points on: emotional regulation, self-esteem, depression and anxiety. A total of 434 pupils took part at time 1, 574 at time 2, and 467 at time 3. The secondary schools were categorised into more and less disadvantaged schools.ResultsPositive self-esteem [F(1.205) = 54.568, P = 0.000; F(1.157) = 35.582, P = 0.000] and emotional regulation [F(1.205) = 46.925, P = 0.000; F(1.157) = 16.583, P = 0.000] were both associated with resilience against depression in adolescents from single parent families. Positive self-esteem [F(1,75) = 102.629, P = 0.000; F(1.355) = 60.555, P = 0.000] and emotional regulation [F(1.60) = 34.813, P = 0.000; F(1.73) = 36.891, P = 0.000] were both associated with resilience against depression in adolescents attending more socio-economically challenged areas.ConclusionsThis research suggests that adolescent resilience against depression may be promoted by improving self-esteem and emotional regulation. Therefore, future interventions could focus on boosting these resilience factors. Further resilience research could include emotional regulation and self-esteem as protective factors for resilience in adolescent mental health. As these variables have been identified, they can help find more pieces to the complex puzzle of resilience.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Considerable focus has been given to the interpersonal nature of the voice-hearing relationship and how appraisals about voices may be linked with distress and depression (the 'cognitive model'). Research hitherto has focused on appraisals of voice power, but the supportive and affiliative quality of voices, which may act to mitigate distress, is not understood. We explored appraisals of voices' power and emotional support to determine their significance in predicting depression and suicidal thought. We adapted the concept of expressed emotion (EE) and applied it to measure voice hearers' perception of the relationship with their voice(s). In a sample of 74 voice hearers, 55.4% were moderately depressed. Seventy-eight who rated their voices as high in both power and EE had a large and significant elevation in depression, suggesting that co-occurrence of these appraisals impacts on depression. Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE. Those rating their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. These findings highlight the protective role that the supportive dimension of the voice/voice-hearer relationship may have.

Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors.This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15-24 years.This study used a matched case-control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse.Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15-18 years, work stress in women aged 19-24 years.Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care.

This study explores the mental health needs of teachers and how these might impact on their capacity to provide early identification and intervention strategies to support their student's emotional well-being.The present study surveyed a sample of UK teachers (N = 320) to explore the impact of work-related stress on their mental health and their ability to provide early intervention support for their students.Our survey showed high levels of work-related stress due to time pressures and excessive workloads; many teachers failed to seek help for their stress often due to stigmatic attitudes and fear of negative response by senior management. Such factors led some to withdraw from taking on extra responsibilities with regard to student support and to consider leaving the teaching profession altogether. Coping mechanisms included the use of alcohol and tobacco, with only a small minority receiving access to psychological therapies.High levels of work-related stress in teachers can have serious consequences for their mental health and impede their ability to provide effective early intervention support for their student's emotional well-being. Improvements in mental health training for teachers and greater assistance for their own mental health needs are necessary.

BackgroundInterventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.AimsTo document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway.MethodData for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed.ResultsA third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP.ConclusionsCommunity education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.Declarations of interestNone.

Aims: To examine the self-critical thoughts and self-reassuring meta-cognitive capacity of those who hear voices and explore whether they are associated with the theme of voice content and appraisals of voice power and voice expressed emotion. Method: A cross-sectional design was used, combining semi-structured interviews and self-report measures. Data on symptomatology, self-critical thoughts and self-reassuring meta-cognitive capacity, thematic voice content, and appraisals of voice power and expressed emotion were collected from 74 voice-hearers in Birmingham, UK. Results: Common themes of voice content reflected issues of shame, control, and affiliation. Controlling content was the most prevalent theme, however, no significant predictor of this theme was found; shaming thematic voice content linked with reduced capacity to self-reassure following self-critical thoughts. Voice-hearers with the greatest level of self-critical thoughts appraised their voices as powerful and high in voice expressed emotion. Conclusions: Findings suggest that voice-hearers self-critical thoughts are reflected in the type of relationship they have with their voice. However, access to self-reassuring meta-cognitive capacity may serve as a protective factor for those who hear voices, resulting in more benign voice content. These findings highlight the importance of this specific meta-cognitive capacity and will inform future therapeutic interventions for the management of voices in this vulnerable group.

Background: Reducing the duration of untreated psychosis (DUP) is an aspiration of international guidelines for first episode psychosis; however, public health initiatives have met with mixed results. Systematic reviews suggest that greater focus on the sources of delay within care pathways, (which will vary between healthcare settings) is needed to achieve sustainable reductions in DUP (BJP 198: 256-263; 2011).\ud Methods/Design: A quasi-experimental trial, comparing a targeted intervention area with a ‘detection as usual’ area in the same city. A proof-of–principle trial, no a priori assumptions are made regarding effect size; key outcome will be an estimate of the potential effect size for a definitive trial. DUP and number of new cases will be collected over an 18-month period in target and control areas and compared; historical data on DUP collected in both areas over the previous three years, will serve as a benchmark. The intervention will focus on reducing two significant DUP component delays within the overall care pathway: delays within the mental health service and help-seeking delay.\ud Discussion: This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay.\ud Trial registration: http://www.controlled-trials.com/ISRCTN45058713\ud Keywords: Public mental health campaign, First-episode psychosis, Early detection, Duration of untreated psychosis, Youth mental health\ud

Considerable focus has been given to the interpersonal nature of the voice-hearing relationship and how appraisals about voices may be linked with distress and depression (the 'cognitive model'). Research hitherto has focused on appraisals of voice power, but the supportive and affiliative quality of voices, which may act to mitigate distress, is not understood. We explored appraisals of voices' power and emotional support to determine their significance in predicting depression and suicidal thought. We adapted the concept of expressed emotion (EE) and applied it to measure voice hearers' perception of the relationship with their voice(s). In a sample of 74 voice hearers, 55.4% were moderately depressed. Seventy-eight who rated their voices as high in both power and EE had a large and significant elevation in depression, suggesting that co-occurrence of these appraisals impacts on depression. Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE. Those rating their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. These findings highlight the protective role that the supportive dimension of the voice/voice-hearer relationship may have.

PTSD et psychose constituent une comorbidite desormais admise et suffisamment documentee. Son incidence n’est pas bien determinee mais, selon les etudes, elle peut varier entre 11 % et 67 %, apres un episode psychotique aigu. La symptomatologie anxieuse post-traumatique n’est pas bien recherchee par le praticien et, par consequent, elle est mal identifiee et souvent confondue avec les manifestations du registre psychotique. Or, le syndrome PTSD se presente, meme dans ce contexte clinique de comorbidite, avec une typicite suffisante (DSM-IV) pour les trois quarts des patients et avec une allure infraclinique pour les deux tiers des patients. Le facteur stressant, en ces circonstances, est moins directement associe a la symptomatologie psychotique elle-meme (puissance des hallucinations auditives, menaces persecutives, idees delirantes) qu’a la perception subjective du patient de l’impact de la psychose sur sa vie et son identite. Le statut de « malade mental » est une perception subjective bouleversant l’equilibre identitaire du patient et donnant lieu a des emotions de honte et de stress. Les questionnaires mettent en avant que le facteur declenchant de cette symptomatologie anxieuse est l’experience de l’hospitalisation en milieu specialise (souvent sous contrainte). A la suite de C. Rodwell [25], la notion d’autonomie et d’implication subjective (empowerment) chez les personnes confrontees a la maladie et aux experiences de soins a pris une importance croissante. Le patient ayant subi un episode psychotique aigu, et de surcroit le premier, vit un sentiment profond de perte de l’autonomie (lack of empowerment) lie a l’effondrement psychotique. Les ressources psychotherapiques et chimiotherapiques a developper de maniere specifique devant ce mode evolutif sont ici discutees, autour d’une strategie de soins tenant compte de la necessite de la preservation et de la recuperation du sentiment d’implication subjective.