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Background: Few studies have assessed associations between mental wellbeing (MWB) and productivity loss using nationally-representative longitudinal data. The objective of the study was to determine how different levels of MWB are associated with future productivity loss or costs due to sickness absence. Methods: Data stem from a Danish nationally representative panel study of 1,959 employed adults (aged 16–64 years old) conducted in 2019 and 2020, which was linked to Danish register data. The validated Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) was used to assess MWB in 2019. The outcome was days absent from work due to sickness in 2020. Linear regression models were used to predict sickness absence in 2020 while adjusting for sickness absence in 2019, sociodemographics and health status, including psychiatric morbidity. Productivity loss or costs were estimated using the human capital approach (HCA) and friction cost approach (FCA). Costs are expressed in USD PPP. Results: Each point increase in MWB was significantly associated with fewer sick days in 2020 and, by extension, lower productivity loss (reported in the order HCA/FCA). As compared to low MWB, moderate MWB was associated with $-1,614/$-1,271 per person in 2020, while high MWB was associated with $-2,351/$-1,779 per person in 2020. Extrapolated to the Danish population (2.7 M employed adults aged 16–64) and as compared to low MWB (12.3% of the population), moderate MWB (67.3% of the population) was associated with lower productivity loss amounting to $-2.9bn/$-2.3bn in 2020, while high MWB (20.4% of the population) was associated with lower productivity loss amounting to $-1.3bn/$-0.9bn in 2020. Conclusions: Higher levels of MWB are associated with considerably less productivity loss. Substantial reductions in productivity loss could potentially be achieved by promoting higher levels of MWB in the population workforce.

Purpose To identify patterns and problems in completing composite time trade-off (C-TTO) and discrete choice experiment (DCE) exercises for the valuation of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) to inform the optimisation of a valuation protocol. Methods Fourteen cognitive interviews were conducted in the UK using concurrent and retrospective think-aloud and probing techniques. Each participant completed 8 C-TTO tasks and 8 DCE tasks within a computer-assisted personal interview setting. Verbal information was transcribed verbatim. Axial coding and thematic analysis were used to organise the qualitative data and identify patterns and problems with the completion of tasks. Results While participants found the tasks generally manageable, five broad themes emerged to explain and optimise the response to the tasks. (1) Format and structure: attention to the design of practice examples, instructions, and layout were needed. (2) Items and levels: underlying relationships were discovered across different combinations of levels of SWEMWBS items. (3) Decision heuristics: participants engaged in diverse strategies to assist trade-off decisions. (4) Valuation feasibility: certain states were difficult to imagine, compare and quantify. (5) Valuation outcome: the data quality was affected by participants’ discriminatory ability across states and their time trade-off decisions. Conclusion The interviews contributed insights regarding the robustness of the proposed methods. The application of C-TTO and DCE valuation techniques was practical and suitable for capturing individual attitudes towards different mental well-being scenarios. A modified protocol informed by the results is being tested in a larger sample across the UK.

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.

Background Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this study, a prospective analysis was conducted on Danish data to determine 1) the association between mental well-being (measured in 2016) and government expenditure in 2017, specifially healthcare costs and sickness benefit transfers. Methods Data stem from a Danish population-based survey of 3,508 adults (aged 16 + years) in 2016, which was linked to Danish registry data. A validated scale (WEMWBS) was used for the assessment of mental well-being. Costs are expressed in USD PPP. A two-part model was applied to predict costs in 2017, adjusting for sociodemographics, health status (including psychiatric morbidity and health behaviour), as well as costs in the previous year (2016). Results Each point increase in mental well-being (measured in 2016) was associated with lower healthcare costs ($− 42.5, 95% CI = $− 78.7, $− 6.3) and lower costs in terms of sickness benefit transfers ($− 23.1, 95% CI = $− 41.9, $− 4.3) per person in 2017. Conclusions Estimated reductions in costs related to mental well-being add to what is already known about potential savings related to the prevention of mental illness. It does so by illustrating the savings that could be made by moving from lower to higher levels of mental well-being both within and beyond the clinical range. Our estimates pertain to costs associated with those health-related outcomes that were included in the study, but excluding other social and economic outcomes and benefits. They cover immediate cost estimates (costs generated the year following mental well-being measurement) and not those that could follow improved mental well-being over the longer term. They may therefore be considered conservative from a societal perspective. Population approaches to mental health promotion are necessary, not only to potentiate disease prevention strategies, but also to reduce costs related to lower levels of mental well-being in the non-mental illness population. Our results suggest that useful reductions in both health care resource use and costs, as well as in costs due to sick leave from the workplace, could be achieved from investment in mental well-being promotion within a year.

Purpose This study assesses the construct validity and sensitivity to change of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) as an outcome measure in the treatment of common mental disorders (CMD) in primary care settings. Methods 127 participants attending up to 5 sessions of therapy for CMD in primary care self-rated the SWEMWBS, the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. SWEMWBS’s construct validity and sensitivity to change was evaluated against the PHQ-9 and GAD-7 across multiple time points in two ways: correlation coefficients were calculated between the measures at each time point; and sensitivity to change over time was assessed using repeated measures ANOVA. Results Score distributions on SWEMWBS, but not PHQ-9 and GAD-7, met criteria for normality. At baseline, 92.9% (118/127) of participants scored above clinical threshold on either PHQ-9 or GAD-7. Correlations between SWEMWBS and PHQ-9 scores were calculated at each respective time point and ranged from 0.601 to 0.793. Correlations between SWEMWBS and GAD-7 scores were calculated similarly and ranged from 0.630 to 0.743. Significant improvements were seen on all three scales over time. Changes in PHQ-9 and GAD-7 were curvilinear with greatest improvement between sessions 1 and 2. Change in SWEMWBS was linear over the five sessions. Conclusions This exploratory study suggests that SWEMWBS is acceptable as a CMD outcome measure in primary care settings, both in terms of construct validity and sensitivity to change. Given patient preference for positively over negatively framed measures and statistical advantages of measures which are normally distributed, SWEMWBS could be used as an alternative to PHQ-9 and GAD-7 in monitoring and evaluating CMD treatment.

Introduction: Existing patient reported outcome measures (PROMs) do not capture all holistic outcomes observed in Traditional, Complementary and Integrative Medicine (TCIM). This study reports development and validation of a PROM to support research on craniosacral therapy (CST) and other TCIMs.\ud \ud Methods: Using a conceptual framework and items developed and evaluated with clients and practitioners in a CST setting, a questionnaire was developed and tested using mixed methods approaches. Evaluation included an iterative process. Psychometric tests: structural validity (exploratory factor analysis, EFA), internal consistency (Cronbach's alpha), convergent validity (correlations with Warwick-Edinburgh Mental Wellbeing Scale, Short Form-12v2 (SF-12), Harry Edwards Healing Impact Questionnaire), repeatability and responsiveness (t-tests; intra class coefficients, ICC).\ud \ud Results: The Warwick Holistic Health Questionnaire (WHHQ-18) was resolved covering mental, physical, emotional and spiritual wellbeing, self-awareness, engaging in life, responsibility for self, living in the moment and satisfaction with life.\ud \ud EFA revealed four correlated sub-scales. Internal reliability was good (alpha = 0.852). Convergent validity showed strong positive correlation with other wellbeing measures, but no correlation with health-related quality of life (SF-12). Repeatability testing showed good agreement (ICC=0.822) and no differences in scores for test-retest (paired t-test: t = 0.355, p = 0.723). Responsiveness analysis showed significant differences in scores (paired t-test t = 6.15, p < 0.001) with 46% of participants having an effect size of 0.5 or more.\ud \ud Conclusion: WHHQ-18 is the first PROM developed for CST practice and captures outcomes important to TCIM more broadly. Good internal consistency, test-retest reliability and responsive at individual and group level make this new PROM an attractive resource for evaluators. Lack of convergent validity with SF-12 scales suggests WHHQ-18 be added to rather than replace HRQol measures in clinical studies.

BackgroundFew studies have investigated the protective role of higher levels of wellbeing in relation to common mental disorders (CMDs). The objective of this study was to explore the protective role of mental wellbeing at baseline on CMDs during a 12–16 months follow-up period in the Danish general population.MethodsData stem from a Danish nationally-representative panel study of 6629 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to Danish register data. A validated scale (SWEMWBS) was used to assess mental wellbeing, along with pre-defined cut-points for low/moderate/high mental wellbeing. Register-based outcomes were 1) onset of ICD-10 CMDs, and 2) onset or recurrence of antidepressant use. The survey-based outcome was case depression based on a screening tool (PHQ-8 score≥10). Register-based analyses (N = 6624) were conducted with Cox regression, and the survey-based analysis (N = 5000) was conducted with logistic regression.ResultsMental wellbeing was negatively associated with all outcomes, both continuously and dose-dependently. Notably, as compared to low mental wellbeing, moderate mental wellbeing was associated with a 55–68% reduction in risk for all outcomes (onset of ICD-10 CMDs; onset or recurrence of antidepressant use; onset or recurrence of case depression based on the PHQ-8), while high mental wellbeing was associated with a 69–90% reduction in the same outcomes.ConclusionsHigher levels of mental wellbeing are protective against onset or recurrence of CMDs. Future studies are warranted to investigate the effectiveness of universal and targeted approaches to promote mental wellbeing and prevent CMDs.

Whereas in the past, resilience was seen as a character trait of the few, enabling a ‘bounce back’ to some prior healthy state, it is described as something that is transitional, that enables a ‘bouncing forward’ for all those who experience growth from having survived or even thrived through challenging experiences. This interpretation enables action as it opens the possibility of exploring what can be put in place to ensure these experiences can be opportunities for positive change for all, leading to improved mental well-being and physical health. While for most migrants the act of migration is an active choice driven by hopes for life improvement, migration can create challenges. For refugee and asylum-seeker populations, who have been the focus of most migrant-resilience research, their status suggests an increased likelihood of having experienced adversity and a risk of experiencing ongoing challenges. Qualitative studies with migrant populations indicate high levels of resilience, including personal characteristics, beliefs, behaviours, and cultural understandings that enable people to survive and even thrive following such experiences. Policies and interventions to support resilience should include both external protective factors such as access to basic human needs, social integration and relationships in destination countries, and services for those who require intervention. Few intervention studies use asset-focused outcomes such as resilience and well-being, and there is an opportunity for established and emerging therapies to use these to enhance evaluation and understanding.

BackgroundChildhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations.MethodsUsing the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood.ResultsA quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict.ConclusionIndividuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.

Background Mental well-being is fundamental for a good life. Previous literature has examined the predictors of mental disorders and continuous measures of positive mental health. Very few studies have specifically focused on the predictors of different levels of mental well-being, but those that have suggest a different picture. This study aimed to compare socioeconomic and relational/recreational behaviour predictors of different levels of mental well-being as well as common mental disorders (CMDs). Methods Data from 3508 adults aged 16+ years old from the Danish Mental Health and Well-Being Survey 2016 were linked to Danish national register-based data. Mental well-being was assessed using the Warwick-Edinburgh Mental Well-being Scale, and information on CMDs was assessed using the Patient Health Questionnaire (PHQ-4). Regression analyses were conducted to estimate the predictors of low and high mental well-being compared to moderate mental well-being and also of CMDs. Results Lower socioeconomic position (education, income and employment status) was associated with increased odds of low mental well-being and the presence of CMDs, but did not significantly predict high mental well-being. Relational/recreational behaviours (informal and formal social participation, social support and recreational activity) were associated with reduced odds of low mental well-being and CMDs, and also with increased odds of high mental well-being. Conclusions Socioeconomic predictors of high mental well-being do not mirror those of low mental well-being and CMDs, whereas relational/recreational predictors of high mental well-being do mirror those of low mental well-being and CMDs. These findings have important implications for public mental health strategies.

Paediatricians and healthcare professionals working with children are well placed to observe parents and see a wide range of parenting from the exceptional to the abusive. Parenting has important short, medium and long term effects on child physical and mental health. Understanding these effects more fully helps paediatricians to comment on parenting, offer advice or refer to parenting programmes. This article outlines advances in neuroscience and attachment theory as well as contemporary issues that underpin the case for parenting intervention. It also discusses the rationale and evidence base for particular programmes, the UK policy context, and makes some suggestions on how paediatricians may wish to support better parenting.

“Modern life has been chipping away at children's happiness over time”; this statement was the pessimistic conclusion of The Good Childhood Report 2020, 1 which focused on wellbeing in children between the ages of 10 and 15 years across the UK. The report emphasised that children in the UK, especially girls, are among the most unhappy and least satisfied in Europe. The UK ranked lowest of 24 European countries in its proportion of children aged 15 years with high life satisfaction, lowest in its proportion with a positive sense of purpose in life, and second highest in its proportion with high sadness levels. Although happiness levels with family life and schoolwork have been stable since 2017–18, unhappiness with life as a whole and with friends continued to deteriorate. Fear of failure was found to show the strongest connection with life satisfaction across countries. There was also some evidence of a link over time with changes in child poverty but not with changes in digital use. These findings have important implications for education, social policy, and public health as child poverty and fear of failure relate to sectors where there have been changes in Government policy in the UK and devolved nations (eg, austerity, schooling, the new curriculum, exam changes, and the development of new academies).

Globally, promoting mental wellbeing among adolescents is of great public health and social significance. However, less is known about advances in measures of mental wellbeing, relevant for use in mental health interventions, which are age-appropriate and acceptable for use among adolescents. Comprehensive assessment includes multiple aspects of mental wellbeing, as well as positive indicators of feeling and functioning. This review used systematic review methods, guided by PRISMA, to identify and assess comprehensive instruments in terms of their content, conceptual relevance for youth, and responsiveness to change. Ryan and Deci’s framework for mental wellbeing, grounded in hedonic and eudaimonic perspectives, was applied to assess the preponderance of feeling and functioning items for each instrument. The review identified 11 instruments that fit specified inclusion criteria. Only four of the scales were developed for adolescents. Though the scales varied in their preponderance of items, all scales encompassed at least one indicator of both feeling and functioning. Findings emphasize the importance of validating adult-developed instruments for youth and ensuring the instrument’s cultural and conceptual relevance within groups of adolescents. As promoting mental wellbeing becomes critical to the field of practice, practitioners need access to relevant and acceptable measures.

Objectives: There is a theoretical basis for believing that healthy lifestyle interventions can improve mental well-being and evidence to show that mental well-being is protective of future health. This study contributes to the evidence base by examining changes in mental well-being associated with the One Body One Life (OBOL) healthy lifestyle programme in a community setting in the West Midlands. Study design: Quantitative, before and after the evaluation. Methods: We conducted a before and after study of the lifestyle intervention ‘OBOL’, a multi component intervention that includes exercise and healthy eating education. Mental wellbeing was measured with the Warwick- Edinburgh Mental Well-being Scale. Physical activity and fruit and vegetable consumption were self-reported. Measures were collected before and after the 12-week intervention and three months post completion. Nonparametric tests were used to assess differences between groups, and linear mixed models were used to assess change over time. Results: Four hundred and eighty-one (81% of attendees) adult participants completed a valid Warwick-Edinburgh Mental Well-being Scale before starting OBOL; of whom, 63.8%completed the Warwick-Edinburgh Mental Well-being Scale immediately post intervention and 25.2% at three months. Mental well-being levels increased significantly (P < 0.001)over the course of the intervention and were sustained at the three-month follow-up(baseline median Warwick- Edinburgh Mental Well-being Scale score ¼ 48 [interquartile range 41e55], completion ¼ 53 [interquartile range 46e57], 3-month follow-up ¼ 52[interquartile range 46e56]). Change in mental well-being was clinically significant after accounting for age and gender. Changes in both fruit and vegetable consumption and physical activity appeared to explain some but not all of the variation in mental well-being. Conclusion: We found significant improvements in mental well-being among participants directly after the intervention which were sustained at the three-month follow-up. These findings contribute to a growing body of knowledge on the contribution of lifestyle interventions to promoting and sustaining mental well-being.

Objective Evaluating effectiveness and cost-effectiveness of ‘Families for Health V2′ (FFH) compared with usual care (UC).\ud \ud Design Multicentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families.\ud \ud Setting Three National Health Service Primary Care Trusts in West Midlands, England.\ud \ud Participants Overweight or obese (≥91st or ≥98th centile body mass index (BMI)) children aged 6–11 years and their parents/carers, recruited March 2012–February 2014.\ud \ud Interventions FFH; a 10-week community-based family programme addressing parenting, lifestyle change and social and emotional development. UC; usual support for childhood obesity at each site.\ud \ud Main outcome measures Primary outcomes were 12-months change in children's BMI z-score and incremental cost per quality-adjusted life-year gained (QALY). Secondary outcomes included changes in children's physical activity, fruit and vegetable consumption and quality of life, parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style.\ud \ud Results 115 families (128 children) were randomised to FFH (n=56) or UC (n=59). There was no significant difference in BMI z-score 12-months change (0.114, 95% CI −0.001 to 0.229, p=0.053; p=0.026 in favour of UC with missing value multiple imputation). One secondary outcome, change in children's waist z-score, was significantly different between groups in favour of UC (0.15, 95% CI 0.00 to 0.29). Economic evaluation showed that mean costs were significantly higher for FFH than UC (£998 vs £548, p

Purpose The Warwick–Edinburgh Mental Well-being Scale (WEMWBS), 14 positively worded statements, is a validated instrument to measure mental wellbeing on a population level. Less is known about the population distribution of the shorter seven-item version (SWEMWBS) or its performance as an instrument to measure wellbeing. Methods Using the Health Survey for England 2010–2013 (n = 27,169 adults aged 16+, nationally representative of the population), age- and sex-specific norms were estimated using means and percentiles. Criterion validity was examined using: (1) Spearman correlations (ρ) for SWEMWBS with General Health Questionnaire (GHQ-12), happiness index, EQ-VAS (2) a multinomial logit model with SWEMWBS (low, medium and high wellbeing) as the outcome and demographic, social and health behaviours as explanatory variables. Relative validity was examined by comparing SWEMWBS with WEMWBS using: (1) Spearman correlations (continuous data), and (2) the weighted kappa statistic (categorical), within population subgroups. Results Mean (median) SWEMWBS was 23.7 (23.2) for men and 23.2 (23.2) for women (p = 0.100). Spearman correlations were moderately sized for the happiness index (ρ = 0.53, P

BackgroundEffective programmes to help children manage their weight are required. ‘Families for Health’ focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project.ObjectiveThe aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT).DesignThe trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families.SettingThree sites in the West Midlands, England, UK.ParticipantsChildren aged 6–11 years who were overweight (≥ 91st centile BMI) or obese (≥ 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral.InterventionsFamilies for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality.Main outcome measuresJoint primary outcome measures were change in children’s BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months’ follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children’s waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents’ BMI and mental well-being, family eating/activity, parent–child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods.ResultsThe study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the ‘usual-care’ control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) –0.001 to 0.229;p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (–0.118, 95% CI –0.203 to –0.034;p = 0.007), but not in the Families for Health arm (–0.005, 95% CI –0.085 to 0.078;p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care (£998 vs. £548;p ConclusionsFamilies for Health was neither effective nor cost-effective for the management of obesity in children aged 6–11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment.Trial registrationCurrent Controlled Trials ISRCTN45032201.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.

This study examined the psychometric properties of the Danish WEMWBS and its short version (SWEMWBS) in a Danish population sample, and compared scores in Denmark with scores representative of three other European settings. A total of 3,508 Danish men and women aged 16-95 filled out an electronic survey. Face validity was examined by cognitive interviews. Content validity was assessed by examining response distributions and construct validity by confirmatory factor analysis, measurement invariance, and relations to other or similar measures. Overall mental well-being scores were calculated, as well as stratified by sex and age. Support was found for the single-factor hypothesis, yielding good model fits for both versions of the scale. Both scales have high internal consistency. Correlations with mental health measures were largely in line with expectations. The highest mental well-being scores were reported for Catalonia, followed by Denmark, Iceland, and England. The (S)WEMWBS appear to be appropriate instruments to measure mental well-being in the Danish population. The present findings encourage the use of the scales, particularly SWEMWBS, in epidemiological, intervention and evaluation studies in research and practice. Cross-cultural comparisons like the one reported here may be essential to inform international mental health policy.

Background SWEMWBS is a popular measure of mental wellbeing, shown to be valid in clinical populations. Responsiveness to change has not yet been formally assessed. Methods Analysis of data from a clinical sample of 172 clients undergoing up to 4 sessions of cognitive hypnotherapy. Cohen’s D effect size (ES), Standardised response mean (SRM), probability of change statistic (P^) were used to evaluate whether SWEMWBS detected statistically important changes at the group level. Cohen’s D effect size (ES) and Standard error of measurement (SEM) and were used to evaluate whether SWEMWBS detected statistically important changes at the individual level. Results Mean (SD) SWEMWBS scores increased from baseline to therapy 4 from 19.28 (3.921) to 23.32 (4.873). At group level, using Cohen’s D effect size, improvement ranges from ES = 0.20–1.41 and using SRM, ranged from 0.30–0.88, increasing with number of therapy sessions. (P^) ranged from 0.65–0.8. At individual level, use of Cohens D ES > 0.5 indicated statistically important improvement in 29.9–86.1% cf. 20.1–80.6% using a standard of 2.77 SEM (2.87 points). The lower threshold of 1 SEM (1.03 points) indicated statistically important improvement in 43.0–81.0%. Conclusion SWEMWBS is responsive to change at individual and group level. At individual level a change of between 1 and 3 points meets thresholds for statisticially important change, depending on standard used. Anchor based studies are necessary to confirm that such change represents minimally important change from the perspective of study participants.

We need more GPs in the UK if we are to manage our ageing and increasingly multi-morbid population. However, there is a manpower crisis in NHS primary care, with GP recruitment falling and older doctors taking early retirement. Although there has been considerable research into medical staff stress, there are relatively few studies of coping and resilience in doctors. However, there is some evidence that intensive, brief resilience training can be beneficial. Our aim was to establish if REFRAME could help GPs develop skills that improve their well-being and resilience and to establish whether participants feel the outcome measures employed capture their experience.

Purpose – It is important within public health goals to promote adolescents’ mental health and to reduce socioeconomic inequalities in mental health. Among adults there are indications that the socioeconomic pattern of low positive mental health (PMH) differs from the socioeconomic pattern of high PMH. Knowledge regarding the social epidemiology of PMH among young people is lacking. The purpose of this paper is to examine the socioeconomic patterning of aspects of low and high PMH among adolescents. Design/methodology/approach – The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3,670 adolescents aged 11-15 in two municipalities in Denmark. Socioeconomic differences in aspects of low and high PMH (self-esteem, social competence and self-efficacy) were investigated by calculating sex-specific prevalence of PMH in socioeconomic groups measured by parents’ occupational social class. Using multi-level logistic regression analyses, odds ratios for low and high PMH compared to moderate PMH were estimated. Findings – In age-adjusted analyses there seemed to be a graded relationship with increasing odds for low PMH with decreasing socioeconomic position, but no indication of a socioeconomic patterning of high PMH. The prevalence of high self-esteem and high self-efficacy was higher among boys than girls. High social competence and high self-efficacy increased with age. Research limitations/implications – Public health research has primarily focused on risk factors and mental health problems. Research highlighting more detailed aspects of PMH is needed. Originality/value – The socioeconomic pattern of high PMH may be different from the socioeconomic pattern of low PMH.

Resilience and well-being are relatively new to public health and psychiatry, and the research that underpins the concepts is often found in the publications of other disciplines—psychology, neuroscience, physiology, and philosophy. This chapter argues, using ideas from a range of disciplines, that resilience and well-being are integrally linked in that resilience is a product, a marker, and a developer of mental well-being. A level of well-being commensurate with a particular challenge enables a resilient response, and by enabling development in the face of the challenge, resilience enhances well-being. Both resilience and well-being are developmental and the key to successful development is a sensitive, attuned, and trusting relationship, which conditions the self-regulation response. Approaches to enhancing resilience and well-being are therefore very similar. They start with relational support in infancy and childhood, and carry on throughout the life course, with activities and programmes that support the development of self–regulation.

Public health is an art and science that has been successfully applied to physical health. It is a practice for which the principles are now well known. Public mental health is a new application to which many of the principles are directly transferable. However, the nature of mental health challenges some of these principles and means that they need to be applied with a degree of caution. New principles need to be developed to allow for consideration of complexity and the need for system change, as well as of positive states of health and enabling personal development.

This chapter presents the epidemiological research on childhood behaviour disorder and argues that this disorder is not a clinical entity but the tail end of a spectrum of behaviour. Other examples of disorders with these epidemiological characteristics include hypertension (high blood pressure), high cholesterol and alcohol misuse. There is strong theoretical and research evidence to suggest that these disorders are more effectively prevented using a 'population' rather than a high-risk or secondary prevention approach. Parent training programmes have been used by the statutory services (social, health and education) in both high-risk and secondary preventive approaches for some years. The research evidence showing that programmes are effective in these settings is strong. At present, the voluntary sector is the main provider of parent training using a population approach. Preliminary and qualitative and observational studies suggest that these are also effective in a population setting, but no trials have been carried out. Childhood behaviour disorder is now the most common cause of disability in childhood and there is good evidence to suggest that it is an important risk factorfor many common disorders of adolescence and adulthood, including mental illness, family violence, and unhealthy lifestyles. The most promising solution to this twentieth century epidemic is parent support and training for all parents. More research is needed to define which types of programmes should be provided and how.

GWAS have identified a breast cancer susceptibility locus on 2q35. Here we report the fine mapping of this locus using data from 101,943 subjects from 50 case-control studies. We genotype 276 SNPs using the ‘iCOGS’ genotyping array and impute genotypes for a further 1,284 using 1000 Genomes Project data. All but two, strongly correlated SNPs (rs4442975 G/T and rs6721996 G/A) are excluded as candidate causal variants at odds against >100:1. The best functional candidate, rs4442975, is associated with oestrogen receptor positive (ER+) disease with an odds ratio (OR) in Europeans of 0.85 (95% confidence interval=0.84−0.87; P=1.7 × 10−43) per t-allele. This SNP flanks a transcriptional enhancer that physically interacts with the promoter of IGFBP5 (encoding insulin-like growth factor-binding protein 5) and displays allele-specific gene expression, FOXA1 binding and chromatin looping. Evidence suggests that the g-allele confers increased breast cancer susceptibility through relative downregulation of IGFBP5, a gene with known roles in breast cell biology., Previous studies identified an association between the 2q35 locus and breast cancer. Here, the authors show that a SNP at 2q35, rs4442975, is associated with oestrogen receptor positive disease and suggest that this effect is mediated through the downregulation of a known breast cancer gene, IGFBP5.

Integrated health care differs from orthodox care in a number of ways one of which is that many of the complementary and alternative medicines that contribute to integrated care include a focus on improving wellbeing. Concepts of wellbeing derive from diverse disciplines, but all agree that wellbeing is more than the absence of disease. Current conversations about its nature focus on mental wellbeing rather than the physical aspects which are already reasonably well addressed and spiritual components which remain ‘a step too far’ for many. The currently accepted definition of mental wellbeing – feeling good and functioning well – encompasses also concepts from several disciplines. Outcome measurement is important for evaluation in all aspects of health care, and traditional disease-specific measures rarely perform well in the evaluation of interventions designed to enhance wellbeing. There are therefore strong arguments for incorporating measures of mental wellbeing in the evaluation of integrated health care and a range of wellbeing or proxy wellbeing measures are already in use in the context. These may be used in conjunction with disease-specific measures. One wellbeing measure deserves particular attention in the UK because it has been incorporated in government health and social care outcomes frameworks, so demonstrating effectiveness with this measure carries added value. This measure, Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is well validated, sensitive to the changes occurring in integrated health care settings, and well-liked by practitioners, patients and the public. Undertaking comparative evaluations of integrated health care using WEMWBS as an outcome could strengthen arguments for its provision in government funded integrated care.

Genome-wide association studies (GWAS) and large-scale replication studies have identified common variants in 79 loci associated with breast cancer, explaining ∼14% of the familial risk of the disease. To identify new susceptibility loci, we performed a meta-analysis of 11 GWAS, comprising 15,748 breast cancer cases and 18,084 controls together with 46,785 cases and 42,892 controls from 41 studies genotyped on a 211,155-marker custom array (iCOGS). Analyses were restricted to women of European ancestry. We generated genotypes for more than 11 million SNPs by imputation using the 1000 Genomes Project reference panel, and we identified 15 new loci associated with breast cancer at P < 5 × 10(-8). Combining association analysis with ChIP-seq chromatin binding data in mammary cell lines and ChIA-PET chromatin interaction data from ENCODE, we identified likely target genes in two regions: SETBP1 at 18q12.3 and RNF115 and PDZK1 at 1q21.1. One association appears to be driven by an amino acid substitution encoded in EXO1. ispartof: Nature Genetics vol:47 issue:4 pages:373-80 ispartof: location:United States status: published

Objectives Establishing the cross-cultural equivalence of the mental well-being construct, as measured with the Warwick-Edinburg Mental Well-being Scale (WEMWBS), by studying potential construct validity biases in two countries with previously reported score differences. Study Design and Setting We compared the WEMWBS total scores and item responses in Scotland ( N = 779) and Catalonia ( N = 1,900) general population samples. To assess whether the questionnaire spuriously favored higher scores in Catalonia, we tested for differential item functioning (DIF) by applying ordinal logistic regression on Item Response Theory scores. DIF was tested with likelihood ratio tests and standard effect measures (McFadden Pseudo R 2 , >0.13; relative parameter change, >5%), and differential test functioning (DTF) was tested by plotting differences between full-test and purified (i.e., without DIF items) score estimates. Results Catalonia showed higher levels of mental well-being than Scotland (Cohen d = 0.84). Three of 14 WEMWBS items showed small amounts of DIF. DIF did not accrue to DTF, as shown by intraclass correlation coefficient (ICC, 0.999) and case-by-case differences (maximum, 0.12 SD) between total and purified scores. Population differences remained mainly constant across sociodemographics and health outcomes. Conclusion The WEMWBS measures a distinct well-being construct that is stable across countries, implying that Scotland and Catalonia populations are effectively different in the distribution of mental well-being. This result adds to previous psychometric information and supports WEMWBS as a valid unbiased measures for individual and cross-cultural comparisons.

Background To establish the validity and reliability of the Short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) in service users with schizophrenia, depression and anxiety spectrum disorders in Singapore and estimate SWEMWBS scores across socio-demographic and the three psychiatric diagnostic groups in the sample. Methods This secondary analysis was conducted using data from a study among outpatients of a tertiary psychiatric hospital. In addition to the SWEMWBS, socio-demographic data and current psychiatric diagnosis were collected. Service users were also administered the Global Assessment of Functioning (GAF), Patient Health Questionnaire (PHQ)-8, Generalised Anxiety Disorder (GAD)-7, Satisfaction with Life Scale (SWLS) and the Positive Mental Health (PMH) instrument. The SWEMWBS was tested for factorial validity, reliability and convergent and divergent validity. Results In total, 350 service users with a mean (SD) age of 39.1 (11.1) years were included in this study of which 39.4%, 38.9% and 21.7% had schizophrenia, depression and anxiety spectrum disorders, respectively. The single factor structure of the SWEMWBS was confirmed by confirmatory factor analysis (CFI = 0.969, TLI = 0.954, RMSEA = 0.029). The internal consistency reliability was high (Cronbach’s alpha = 0.89). The convergent and divergent validity testing revealed that the SWEMWBS scores had significant moderate to high positive correlations with GAF, SWLS and PMH scores and moderate negative correlations with (PHQ)-8 and (GAD)-7 scores. SWEMWBS scores were higher in married participants (22.2 (5.4) versus never married: 20.7 (5.3) and divorced/separated/widowed: 20.4 (5.1), p = 0.049) and among those with schizophrenia (22.8 (5.5) versus depression:19.6 (4.7) and anxiety spectrum disorders 20.9 (5.2), p

Breast cancer risk is influenced by rare coding variants in susceptibility genes, such as BRCA1, and many common, mostly non-coding variants. However, much of the genetic contribution to breast cancer risk remains unknown. Here we report the results of a genome-wide association study of breast cancer in 122,977 cases and 105,974 controls of European ancestry and 14,068 cases and 13,104 controls of East Asian ancestry. We identified 65 new loci that are associated with overall breast cancer risk at P

The 10q26 locus in the second intron of FGFR2 is the locus most strongly associated with estrogen-receptor-positive breast cancer in genome-wide association studies. We conducted fine-scale mapping in case-control studies genotyped with a custom chip (iCOGS), comprising 41 studies (n = 89,050) of European ancestry, 9 Asian ancestry studies (n = 13,983), and 2 African ancestry studies (n = 2,028) from the Breast Cancer Association Consortium. We identified three statistically independent risk signals within the locus. Within risk signals 1 and 3, genetic analysis identified five and two variants, respectively, highly correlated with the most strongly associated SNPs. By using a combination of genetic fine mapping, data on DNase hypersensitivity, and electrophoretic mobility shift assays to study protein-DNA binding, we identified rs35054928, rs2981578, and rs45631563 as putative functional SNPs. Chromatin immunoprecipitation showed that FOXA1 preferentially bound to the risk-associated allele (C) of rs2981578 and was able to recruit ERα to this site in an allele-specific manner, whereas E2F1 preferentially bound the risk variant of rs35054928. The risk alleles were preferentially found in open chromatin and bound by Ser5 phosphorylated RNA polymerase II, suggesting that the risk alleles are associated with changes in transcription. Chromatin conformation capture demonstrated that the risk region was able to interact with the promoter of FGFR2, the likely target gene of this risk region. A role for FOXA1 in mediating breast cancer susceptibility at this locus is consistent with the finding that the FGFR2 risk locus primarily predisposes to estrogen-receptor-positive disease. © 2013 The American Society of Human Genetics.

SummaryThe Chief Medical Officer's report for 2013 was the first of its kind to highlight the public's mental rather than physical health and thus represents a very important landmark for public health in the UK. Written primarily from the perspective of psychiatrists, the report has created confusion in public health circles by failing to adequately address the public health perspective. David Foreman's editorial in this issue, calling as it does for more training in public health for psychiatrists, is therefore very welcome and timely.

In a consortium including 23 637 breast cancer patients and 25 579 controls of East Asian ancestry, we investigated 70 single-nucleotide polymorphisms (SNPs) in 67 independent breast cancer susceptibility loci recently identified by genome-wide association studies (GWASs) conducted primarily in European-ancestry populations. SNPs in 31 loci showed an association with breast cancer risk at P < 0.05 in a direction consistent with that reported previously. Twenty-one of them remained statistically significant after adjusting for multiple comparisons with the Bonferroni-corrected significance level of, published_or_final_version