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Limited research into professional rugby union players’ experiences of seeking formal support for their mental health exists, despite comparable rates of mental health issues amongst elite rugby players with the general population. This qualitative study explored professional players’ actual experiences of accessing Rugby Players Ireland’s mental wellbeing service, via separate focus group discussions with professional players (n = 5) and player development managers (PDMs, n = 4) who refer players into the service. An inductive reflexive thematic analysis identified three themes detailing players’ (1) journey to disclosure of their mental health difficulties, (2) their expectations and engagement with the wellbeing service, and (3) participants’ reflections on mental health experiences in a high-performance environment. Embedding mental health as a key component of player development in high-performance environments, improving mental health literacy, normalising mental health experiences and encouraging help-seeking would help promote player wellbeing and support holistic development alongside sporting performance.

Bipolar Disorder is associated with high rates of suicidal thoughts, behaviors, and outcomes, yet the lived experience of suicidality and Bipolar Disorder is not particularly well understood. Understanding the role of psychosocial aetiologies in suicidality outcomes for those living with Bipolar Disorder is key for developing appropriately targeted interventions focusing on factors that are amenable to change. In line with PRISMA guidance, we conducted a scoping review to identify the types of psychosocial factors studied in relation to the experience of suicidality for people living with Bipolar Disorder diagnoses. Systematic literature searches identified a sample of 166 articles from which key study data were extracted and charted. A narrative synthesis of the reviewed literature is presented ordered by the factors investigated across studies, a frequency count of the types of psychological/social aetiologies studied, and a brief overview of the key findings for each aetiology. Most of the identified literature took the form of quantitative cross-sectional studies, with only one qualitative study and 18 quantitative prospective studies. The most studied aetiologies were trauma (specifically early adverse experiences and childhood traumas) and stressful life events, impulsivity (primarily subjective self-reported trait impulsivity), social support and functioning, and personality/temperament factors. Only six studies in the final sample reported basing their research questions and/or hypotheses on an explicit theoretical model of suicide. The literature was primarily focused on using self-report measurements of key aetiologies and on factors which lead to worsened suicidality rather than focusing on potentially protective or buffering factors. Future research needs to better justify the aetiologies investigated in relation to suicidality outcomes for people living with Bipolar Disorder, including a firmer basis in theory and hypothesis testing, more prospective de

Purpose: The Social Norms Approach (SNA) is a health behaviour intervention which promotes positive behaviour change by challenging and reducing misperceived social norms of peer behaviours and attitudes. This study reports a novel qualitative evaluation of an in-school SNA intervention which aimed to reduce 11-to-12-year-old students’ unhealthy snacking behaviours by reducing misperceived peer norms. Design: A qualitative evaluation of seven teachers’ and eighteen students’ experiences of taking part in the SNA intervention based on focus group discussions and an open-ended survey. Findings: An inductive reflexive thematic analysis indicated that the SNA intervention was an effective and engaging means of delivering normative feedback to younger adolescents. The use of a paper-and-pens creative poster-making activity, where students were tasked with designing the intervention materials featuring normative feedback based on their baseline data, encouraged students to discuss and reflect on the discrepancies between their perceived norms and the actual reported unhealthy snacking norms. Challenges were identified with ensuring intervention fidelity and in students’ understanding of how to record survey responses using Likert scales. Originality: This study demonstrates the usefulness of exploring post-intervention perceptions of SNA interventions, particularly from the perspective of the intended recipients. The study also provides useful information for those intending to develop in-school SNA interventions in the future, particularly the importance of involving participants in the designing of intervention materials as a means of promoting engagement with an SNA-based dietary behaviour intervention.

Bipolar Disorder is associated with high rates of suicidal thoughts, behaviors, and outcomes, yet the lived experience of suicidality and Bipolar Disorder is not particularly well understood. Understanding the role of psychosocial aetiologies in suicidality outcomes for those living with Bipolar Disorder is key for developing appropriately targeted interventions focusing on factors that are amenable to change. In line with PRISMA guidance, we conducted a scoping review to identify the types of psychosocial factors studied in relation to the experience of suicidality for people living with Bipolar Disorder diagnoses. Systematic literature searches identified a sample of 166 articles from which key study data were extracted and charted. A narrative synthesis of the reviewed literature is presented ordered by the factors investigated across studies, a frequency count of the types of psychological/social aetiologies studied, and a brief overview of the key findings for each aetiology. Most of the identified literature took the form of quantitative cross-sectional studies, with only one qualitative study and 18 quantitative prospective studies. The most studied aetiologies were trauma (specifically early adverse experiences and childhood traumas) and stressful life events, impulsivity (primarily subjective self-reported trait impulsivity), social support and functioning, and personality/temperament factors. Only six studies in the final sample reported basing their research questions and/or hypotheses on an explicit theoretical model of suicide. The literature was primarily focused on using self-report measurements of key aetiologies and on factors which lead to worsened suicidality rather than focusing on potentially protective or buffering factors. Future research needs to better justify the aetiologies investigated in relation to suicidality outcomes for people living with Bipolar Disorder, including a firmer basis in theory and hypothesis testing, more prospective de

Objectives: Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information requests made to NHS trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS trusts. Design: A cross-sectional survey of suicide risk assessment tools and training gathered via Freedom of Information requests and subjected to a content analysis. Setting: Freedom of Information requests were submitted to NHS trusts across England. Results: A wide variety of suicide risk assessments toolsere identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment whilst 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. Conclusions: There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the numbers of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention.

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for m

A high proportion of people contact healthcare services in the 12 months prior to death by suicide. Identifying people at high-risk for suicide is therefore a key concern for healthcare services. Whilst there is extensive research on the validity and reliability of suicide risk assessment tools, there remains a lack of understanding of how suicide risk assessments are conducted by healthcare staff in practice. This scoping review examined the literature on how suicide risk assessments are conducted and experienced by healthcare practitioners, patients, carers, relatives, and friends of people who have died by suicide in the UK. Literature searches were conducted on key databases using a pre-defined search strategy pre-registered with the Open Science Framework and following the PRISMA extension for scoping reviews guidelines. Eligible for inclusion were original research, written in English, exploring how suicide risk is assessed in the UK, related to administering or undergoing risk assessment for suicide, key concepts relating to those experiences, or directly exploring the experiences of administering or undergoing assessment. Eighteen studies were included in the final sample. Information was charted including study setting and design, sampling strategy, sample characteristics, and findings. A narrative account of the literature is provided. There was considerable variation regarding how suicide risk assessments are conducted in practice. There was evidence of a lack of risk assessment training, low awareness of suicide prevention guidance, and a lack of evidence relating to patient perspectives of suicide risk assessments. Increased inclusion of patient perspectives of suicide risk assessment is needed to gain understanding of how the process can be improved. Limited time and difficulty in starting an open discussion about suicide with patients were noted as barriers to successful assessment. Implications for practice are discussed.

Environmental stressors combined with a predisposition to experience mental health problems increase the risk for SI (Suicidal Ideation) among college/university students. However, university health and wellbeing services know little about machine learning methods and techniques to identify as early as possible students with higher risk. We developed an algorithm to identify university students with suicidal thoughts and behaviours using features universities already collect. We used data collected in 2020 from the American College Health Association (ACHA), a cross-sectional population-based survey including 50, 307 volunteer students. A state-of-the-art parallel Markov Chain Monte Carlo (MCMC) Decision tree was used to overcome overfitting problems and target classes with fewer representatives efficiently. Two models were fitted to the survey data featuring a range of demographic and clinical risk factors measured on the ACHA survey. The first model included variables universities would typically collect from their students (e.g., key demographics, residential status, and key health conditions). The second model included these same variables plus additional suicide risk variables which universities would not typically measure as standard practice (e.g., students’ sense of belonging at university). Models’ performance was measured using precision, recall, F1 score, and accuracy metrics to identify any potential overfitting of the data efficiently.

Contemporary theories of suicide, such as the Schematic Appraisals Model (SAMS), hypothesize that negative perceptions of social support are implicated in the pathways to suicidal experiences. The SAMS predicts that perceived social support influences suicidal ideation through appraisals of defeat and entrapment. However, such pathways have not been investigated with people who have bipolar disorder. This prospective four-month study tested the influence of perceived social support on later suicidal ideation via changes in defeat, entrapment, and hopelessness, in a sample of eighty euthymic participants with bipolar disorder (N = 62 at follow-up). Linear regression models tested the extent to which perceived social support at baseline predicted changes in suicidal ideation at four months directly and indirectly via changes in defeat, entrapment, and hopelessness. Perceived social support did not directly predict changes in suicidal ideation, but there was a significant indirect mediational pathway between perceived social support at baseline and changes in suicidal ideation over time, via changes in defeat, entrapment and hopelessness, supporting the SAMS. Psychological interventions which target negative perceptions of social support early, in tandem with addressing defeat, entrapment and hopelessness over time, present a potentially effective approach to counter suicidal ideation in people who experience bipolar disorder.

Objective: Men’s experiences of living with and managing the symptoms associated with Bipolar Disorder are poorly understood. There is also a lack of qualitative studies focused on men’s experiences of Bipolar Disorder despite the clinical importance of this understanding for successfully supporting men to live well and manage mood symptoms. Method: This qualitative study used a photo-elicitation approach to explore how men made sense of managing their mood symptoms when living with Bipolar Disorder. Six participants took photographs representing their experiences of managing their diagnosis and mood symptoms, which formed the basis of in-depth participant-led semi-structured interviews. Results: An Interpretative Phenomenological Analysis identified four themes: (1) ‘managing symptoms: living with the enemy’; (2) ‘we’re not just managing mood episodes’; (3) ‘managing goes beyond a list of strategies’; and (4) ‘medication is a necessary evil’. Common across the sample’s experiences was the importance of accommodating the disruption caused by mood-related triggers and symptoms. Notably, explicit descriptions of masculinity or male identity were absent from the participants’ sense-making. Conclusions: Findings support a clinical focus on promoting idiosyncratic recoveries and living well, focusing on life beyond symptom reduction and relapse prevention, and facilitating ‘sense making’ of men’s Bipolar diagnoses and experiences in practice.

The vulnerability to bipolar disorder is characterized by dysregulated goal-related behavior, the setting of ambitious and extreme goals, and increases in goal approach behaviors. To date, no studies have investigated the nature of goal pursuit behaviors amongst individuals at a behavioral risk for bipolar disorder in terms of whether goal pursuit is characterized by a tenacious active striving for goals or a more flexible changeable focus on goals. A non-clinical sample of 168 participants completed online measures of mood, bipolar-vulnerability, reward sensitivity, goal-related perfectionist tendencies, tenacious goal pursuit and flexible goal adjustment behaviors. Our findings demonstrate that bipolar-vulnerability is characterized by the tenacious, not flexible, pursuit of goals, in combination with low regulation of goal behavior, and tendencies towards narcissistic and self-critical perfectionism indicative of setting high ambitious standards and making overly harsh self-judgments when such standards are not met. These findings are similar to those from clinical bipolar samples where there is evidence of prolonged symptom recoveries after the experience of goal frustrations and failures. Reducing the tenacious, active striving for goals amongst at-risk individuals may be a potential avenue for early intervention.

Contemporary theories of suicide, such as the Schematic Appraisals Model (SAMS), hypothesize that negative perceptions of social support are implicated in the pathways to suicidal experiences. The SAMS predicts that perceived social support influences suicidal ideation through appraisals of defeat and entrapment. However, such pathways have not been investigated in people who have bipolar disorder. This prospective four-month study tested the influence of perceived social support on later suicidal ideation via changes in defeat, entrapment, and hopelessness, in a sample of eighty euthymic participants with bipolar disorder (N = 62 at follow-up). Linear regression models tested the extent to which perceived social support at baseline predicted changes in suicidal ideation at four months directly and indirectly via changes in defeat, entrapment, and hopelessness. Perceived social support did not directly predict changes in suicidal ideation, but there was a significant indirect mediational pathway between perceived social support at baseline and changes in suicidal ideation over time, via changes in defeat, entrapment and hopelessness, supporting the SAMS. Psychological interventions which target negative perceptions of social support early, in tandem with addressing defeat, entrapment, and hopelessness over time, present a potentially effective approach to counter suicidal ideation in people who experience bipolar disorder.

The abuse and neglect of adults at risk is increasingly recognised as a social problem in the U.K. Policy development for the protection of at risk adults has seen substantial growth since the publication of the No Secrets (2000) guidance. Despite cumulative evidence that National Health Service (NHS) mental health services have been slow to engage with the national adult safeguarding agenda, there is a paucity of research in this area. This poster describes a Grounded Theory study designed to explore the use and implementation of adult safeguarding practices and procedures in three NHS mental health trusts. It specifically presents the findings of sixteen interviews with strategic leaders for adult safeguarding and operational personnel. It will discuss the conceptual components that are central to the implementation of effective adult safeguarding procedures in mental health. It further highlights barriers to practice and demonstrate the need for multi-dimensional approaches within service contexts to ensure that factors inevitably affecting mental health service users are anticipated. Such factors include: the perpetuation of social inequalities and power differentials within healthcare settings, the calamitous relationship between the symptoms of abuse and mental illness, and the internalised collusive culture historical to mental health settings.

Objectives Adolescents tend to overestimate the extent of peers’ unhealthy snacking consumption and such misperceptions have been associated with increased personal unhealthy snacking. This study aims to test whether a Social Norms Approach (SNA) intervention which challenges these misperceptions of peers’ unhealthy snacking will have a positive effect on students’ personal unhealthy snacking behaviours, related attitudes, and behavioural intentions. Design A quasi-experimental study tested the effectiveness of an in-school SNA intervention (n = 163) compared to a control condition (n = 95) amongst 11– to 12-year-old students. Method Both conditions received healthy eating information, while students in the SNA intervention received additional normative feedback (outlining the discrepancies between perceived and actual unhealthy snacking of the majority based on baseline data) delivered through an interactive poster-making session. Students completed self-report measures of personal unhealthy snacking, related-attitudes, behavioural intentions, and normative perceptions (descriptive and injunctive) at baseline, post-intervention, and at a 3-month follow-up. Results Students who received SNA feedback were significantly less likely to overestimate peers’ unhealthy snacking attitudes post-intervention (F(1,232) = 16.405, p < .001)), and at 3-month follow-up consumed fewer unhealthy snacks (F(1,232) = 6.133, p = .014)) and had less positive attitudes towards unhealthy snacking (F(1,198) = 8.779, p = .003)). The changes in personal snacking attitudes at 3-month follow-up were mediated by changes in normative misperceptions about peers’ unhealthy snacking attitudes post-intervention, which indicated that the reductions in normative misperceptions following SNA messages mediated the effect of the intervention. Conclusion The results indicate that in-school Social Norms Approach interventions which challenge normative misperceptions constitute a promising strategy for reduc

Conspiracy beliefs are widespread and can have detrimental consequences. As perceived social norms can exert a powerful influence on individuals, we investigated the relationship between perceived conspiracy belief norms and personal endorsement, and whether others’ conspiracy belief is overestimated. In Study 1, UK university students (N = 111) completed measures of their personal conspiracy beliefs and estimations of others’ beliefs (an in-group and an out-group they chose, and a prescribed in-group). Perceived in-groups’ belief strongly predicted personal conspiracy belief; perceived out-group’s belief did not. Studies 2 and 3 replicated these findings in a British community sample (N = 177) and in a UK parent sample (N = 197), focusing on antivaccine conspiracy theories. All studies demonstrated that people overestimate the conspiracy beliefs of others. This is the first demonstration of the association between perceived in-group conspiracy belief social norms and individuals’ personal conspiracy beliefs. Interventions challenging misperceived norms could be effective in reducing conspiracy beliefs.

Anti-vaccine conspiracy beliefs among parents can reduce vaccination intentions. Parents’ beliefs in anti-vaccine conspiracy theories are also related to their perceptions of other parents’ conspiracy beliefs. Further, research has shown that parents hold misperceptions of anti-vaccine conspiracy belief norms: UK parents over-estimate the anti-vaccine conspiracy beliefs of other parents. The present study tested the effectiveness of a Social Norms Approach intervention, which corrects misperceptions using normative feedback, to reduce UK parents’ anti-vaccine conspiracy beliefs and increase vaccination intentions. At baseline, 202 UK parents of young children reported their personal belief in anti-vaccine conspiracy theories, future intentions to vaccinate, and their perceptions of other UK parents’ beliefs and intentions. Participants were then randomly assigned to a normative feedback condition (n = 89) or an assessment-only control condition (n = 113). The normative feedback compared participants’ personal anti-vaccine conspiracy beliefs and perceptions of other UK parents’ beliefs with actual normative belief levels. Parents receiving the normative feedback showed significantly reduced personal belief in anti-vaccine conspiracy beliefs at immediate post-test. As hypothesised, changes in normative perceptions of anti-vaccine conspiracy beliefs mediated the effect of the intervention. The intervention, did not directly increase vaccination intentions, however mediation analysis showed that the normative feedback increased perceptions of other parents’ vaccination intentions, which in turn increased personal vaccination intentions. No significant effects remained after a six-week follow-up. The current research demonstrates the potential utility of Social Norms Approach interventions for correcting misperceptions and reducing anti-vaccine conspiracy beliefs among UK parents. Further research could explore utilising a top-up intervention to maintain the efficacy.

University students’ use of “smart drugs” during the course of their studies appears to be on the rise. “Smart drugs”, more formally known as nootropics (noo = mind, tropic = to turn or change; Cakic, 2009; Giurgea & Salama, 1977), are substances which can be prescribed to improve mental performance, including memory recall, attention and concentration, amongst other cognitive abilities. Nootropic medications are commonly prescribed to reduce the cognitive deficits associated with a number of medically diagnosed conditions, including vascular dementia, stroke, attention-deficit hyperactivity disorder (ADHD), and schizophrenia. Whilst these substances may be legitimately prescribed to address cognitive impairments in clinical populations, there has been a notable increase in societal concern over the use of these substances by healthy individuals as means of improving their cognitive performance without a medical prescription. A key risk group for the non-prescribed use of these stimulant nootropic “smart drugs” are university students, who may use substances such as methylphenidate (“Ritalin”), wakefulness-promoting medications or eugeroics (e.g. modafinil), as well as various legal substances, nutraceuticals and dietary supplements, to improve their performance in their academic studies. The aim of this chapter is to briefly review the use of non-medically prescribed stimulant “smart drugs” by university/college students in higher education, focusing on the psychosocial motivators underlying students’ use of smart drugs to improve academic performance, and an outline of potential interventions for reducing use in this population.

Developing and implementing effective interventions to prevent and intervene with harmful alcohol use remains imperative if the global burden of alcohol related harms is to be reduced and the lives of those affected improved. Excessive alcohol consumption remains a significant public health problem. Worldwide, three million deaths every year are attributed to the harmful use of alcohol (World Health Organization (WHO), 2018). Harmful use is linked to 200 health conditions; including liver disease, cardiovascular diseases, and poor mental health (WHO, 2018). The misuse of alcohol has negative health and social consequences for the individual and wider society. The WHO aims to cut the harmful use of alcohol by 10% by 2025 (WHO, 2018). Recent evidence suggests this target is unlikely to be met, instead it appears that annual consumption of alcohol globally is on the increase (Manthey et al., 2019). Brief alcohol interventions offer one means of rapidly intervening to reduce and avoid harmful alcohol use, particularly via electronic personalised feedback: the aim of this chapter is to review the intervention content, evidence base, effectiveness, future challenges and opportunities associated with the use of electronic brief interventions for alcohol

Background: University students are a risk group for heavy substance use and the experience of various potentially severe negative substance use consequences which may impact on their health, social and academic functioning. Whilst the experience of negative consequences of substance use is well understood in North American student samples, there is little data on these experiences in European students. In order to develop effective harm prevention and reduction interventions for students’ substance use, there needs to be an understanding of the types of consequences experienced in European student samples. Objectives: To investigate the prevalence and predictors of the experience of negative substance use-related consequences amongst university students in seven European countries. Methods: University students (n = 4,482) in Belgium, Denmark, Germany, the Slovak Republic, Spain, Turkey and the United Kingdom, completed an online survey of their substance use behaviours and the experience of associated negative consequences. Results: European students reported that experiencing a hangover or illness, missing class, being short of money and experiencing memory loss, were the most commonly experienced negative consequences of substance use. Not living with other students, using alcohol, cannabis, sedatives and cocaine, were also associated with higher odds of experiencing these negative consequences. Conclusions: In contrast to North American data, European university students tended to experience consequences which are associated with lower level health-risks rather than more severe consequences (e.g. drink-driving, physical injury). Harm prevention and reduction interventions for students should be targeted towards those consequences which are most salient to the target group to ensure feedback is relevant and potentially more effective in changing students’ substance use behaviours.