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1. An exploratory parallel-group randomised controlled trial of antenatal Guided Self-Help (plus usual care) versus usual care alone for pregnant women with depression: DAWN trial

Author: Trevillion, K., Ryan, E.G., Pickles, A., Heslin, M., Byford, S., Nath, S., Bick, D., Milgrom, J., Mycroft, R., Domoney, J., Pariante, C., Hunter, M.S., and Howard, L.M.
Published: 2020
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2. Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

Author: Qiu, X. Wu, Y. Sun, Y. Levis, B. Tian, J. Boruff, J.T. Cuijpers, P. Ioannidis, J.P.A. Markham, S. Ziegelstein, R.C. Vigod, S.N. Benedetti, A. Thombs, B.D. He, C. Krishnan, A. Bhandari, P.M. Neupane, D. Negeri, Z. Imran, M. Rice, D.B. Azar, M. Chiovitti, M.J. Gilbody, S. Kloda, L.A. Patten, S.B. Mitchell, N.D. Alvarado, R. Barnes, J. Beck, C.T. Bindt, C. Correa, H. Couto, T.C. Chorwe-Sungani, G. Eapen, V. Favez, N. Felice, E. Fellmeth, G. Fernandes, M. Field, S. Figueiredo, B. Fisher, J.R.W. Green, E.P. Honikman, S. Howard, L.M. Kettunen, P.A. Kohlhoff, J. Kozinszky, Z. Leonardou, A.A. Maes, M. Martínez, P. Radoš, S.N. Nishi, D. Pawlby, S.J. Rochat, T.J. Rowe, H.J. Sharp, D.J. Skalkidou, A. Smith-Nielsen, J. Stein, A. Su, K.-P. Sundström-Poromaa, I. Tadinac, M. Tandon, S.D. Tendais, I. Töreki, A. Tran, T.D. Trevillion, K. Turner, K. Væver, M.S. van Heyningen, T. Vega-Dienstmaier, J.M. Wynter, K. Yonkers, K.A. the DEPRESsion Screening Data (DEPRESSD) EPDS Group and Qiu, X. Wu, Y. Sun, Y. Levis, B. Tian, J. Boruff, J.T. Cuijpers, P. Ioannidis, J.P.A. Markham, S. Ziegelstein, R.C. Vigod, S.N. Benedetti, A. Thombs, B.D. He, C. Krishnan, A. Bhandari, P.M. Neupane, D. Negeri, Z. Imran, M. Rice, D.B. Azar, M. Chiovitti, M.J. Gilbody, S. Kloda, L.A. Patten, S.B. Mitchell, N.D. Alvarado, R. Barnes, J. Beck, C.T. Bindt, C. Correa, H. Couto, T.C. Chorwe-Sungani, G. Eapen, V. Favez, N. Felice, E. Fellmeth, G. Fernandes, M. Field, S. Figueiredo, B. Fisher, J.R.W. Green, E.P. Honikman, S. Howard, L.M. Kettunen, P.A. Kohlhoff, J. Kozinszky, Z. Leonardou, A.A. Maes, M. Martínez, P. Radoš, S.N. Nishi, D. Pawlby, S.J. Rochat, T.J. Rowe, H.J. Sharp, D.J. Skalkidou, A. Smith-Nielsen, J. Stein, A. Su, K.-P. Sundström-Poromaa, I. Tadinac, M. Tandon, S.D. Tendais, I. Töreki, A. Tran, T.D. Trevillion, K. Turner, K. Væver, M.S. van Heyningen, T. Vega-Dienstmaier, J.M. Wynter, K. Yonkers, K.A. the DEPRESsion Screening Data (DEPRESSD) EPDS Group
Published: 2023

3. Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

Author: Qiu, X, Wu, Y, Sun, Y, Levis, B, Tian, J, Boruff, JT, Cuijpers, P, Ioannidis, JPA, Markham, S, Ziegelstein, RC, Vigod, SN, Benedetti, A, Thombs, BD, He, C, Krishnan, A, Bhandari, PM, Neupane, D, Negeri, Z, Imran, M, Rice, DB, Azar, M, Chiovitti, MJ, Gilbody, S, Kloda, LA, Patten, SB, Mitchell, ND, Alvarado, R, Barnes, J, Beck, CT, Bindt, C, Correa, H, Couto, TCE, Chorwe-Sungani, G, Eapen, V, Favez, N, Felice, E, Fellmeth, G, Fernandes, M, Field, S, Figueiredo, B, Fisher, JRW, Green, EP, Honikman, S, Howard, LM, Kettunen, PA, Kohlhoff, J, Kozinszky, Z, Leonardou, AA, Maes, M, Martínez, P, Radoš, SN, Nishi, D, Pawlby, SJ, Rochat, TJ, Rowe, HJ, Sharp, DJ, Skalkidou, A, Smith-Nielsen, J, Stein, A, Su, KP, Sundström-Poromaa, I, Tadinac, M, Tandon, SD, Tendais, I, Töreki, A, Tran, TD, Trevillion, K, Turner, K, Væver, MS, van Heyningen, T, Vega-Dienstmaier, JM, Wynter, K, Yonkers, KA, Qiu, X, Wu, Y, Sun, Y, Levis, B, Tian, J, Boruff, JT, Cuijpers, P, Ioannidis, JPA, Markham, S, Ziegelstein, RC, Vigod, SN, Benedetti, A, Thombs, BD, He, C, Krishnan, A, Bhandari, PM, Neupane, D, Negeri, Z, Imran, M, Rice, DB, Azar, M, Chiovitti, MJ, Gilbody, S, Kloda, LA, Patten, SB, Mitchell, ND, Alvarado, R, Barnes, J, Beck, CT, Bindt, C, Correa, H, Couto, TCE, Chorwe-Sungani, G, Eapen, V, Favez, N, Felice, E, Fellmeth, G, Fernandes, M, Field, S, Figueiredo, B, Fisher, JRW, Green, EP, Honikman, S, Howard, LM, Kettunen, PA, Kohlhoff, J, Kozinszky, Z, Leonardou, AA, Maes, M, Martínez, P, Radoš, SN, Nishi, D, Pawlby, SJ, Rochat, TJ, Rowe, HJ, Sharp, DJ, Skalkidou, A, Smith-Nielsen, J, Stein, A, Su, KP, Sundström-Poromaa, I, Tadinac, M, Tandon, SD, Tendais, I, Töreki, A, Tran, TD, Trevillion, K, Turner, K, Væver, MS, van Heyningen, T, Vega-Dienstmaier, JM, Wynter, K, and Yonkers, KA
Published: 2023

4. Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model.

Author: Heslin, M, Jin, H, Trevillion, K, Ling, X, Nath, S, Barrett, B, Demilew, J, Ryan, EG, O'Connor, S, Sands, P, Milgrom, J, Bick, D, Stanley, N, Hunter, MS, Howard, LM, Byford, S, Heslin, M, Jin, H, Trevillion, K, Ling, X, Nath, S, Barrett, B, Demilew, J, Ryan, EG, O'Connor, S, Sands, P, Milgrom, J, Bick, D, Stanley, N, Hunter, MS, Howard, LM, and Byford, S
Abstract: BACKGROUND: Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. METHODS: A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. RESULTS: In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000-30,000 per QALY compared to around 20% for the no screen option. CONCLUSIONS: All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. CLINICAL TRIALS REGISTRATION: N/A.
Published: 2022

5. For Baby's Sake: Final Evaluation Report

Author: Trevillion, K., Domoney, J., Ocloo, J., Heslin, M., Ling, X. X., Stanley, Nicky, MacMillan, H., Ramchandani, P., Bick, D., Byford, S., and Howard, L.M.
Subjects: L500
Abstract: For Baby’s Sake is an intervention for expectant parents who want to break the cycle of domestic abuse and support their baby’s early emotional and social development. Both parents join For Baby’s Sake, whether together as a couple or not, and may be supported until their baby is aged two. The programme takes a whole-family approach that deals with the entire cycle and history of domestic violence and abuse, identifying and directly addressing the trauma or traumas that lie at the heart of the problem.\ud \ud The Stefanou Foundation, a UK charity, designed and created For Baby’s Sake and commissioned King’s College London to conduct an independent evaluation of the programme’s operation during the prototype phase in two sites in Hertfordshire and London from 2015-2019.\ud \ud For Baby’s Sake is the culmination of over ten years of investment, eﬀort and continuous learning and the Stefanou Foundation is proud to publish its independent evaluation by a team of researchers from King’s College London, University of Warwick, University of Central Lancashire, University of Cambridge and McMaster University, Canada. The full report is available to download at www.forbabyssake.org.uk\ud \ud The report is being launched in the context of COVID-19 and the creation of new domestic abuse legislation, so this joint summary by the Stefanou Foundation and the academic evaluation team provides some current context before outlining the key findings from the independent evaluation.\ud \ud COVID-19 shines a spotlight on the challenges for those experiencing domestic violence and abuse (DVA) to come forward for support, as well as the physical, emotional and psychological risks and impact of the abuse. The pandemic is also raising questions about how best to support mental health and emotional regulation, especially for those with underlying needs caused by previous trauma. The welcome passage of the domestic abuse legislation through Parliament is drawing attention to the nature of domestic abuse and how best to address it. There are more calls to assist those who perpetrate abuse in changing their behaviour. There is growing recognition of the evidence that children are directly aﬀected by domestic abuse and should be recognised as victims and not simply witnesses.\ud \ud For Baby’s Sake makes a distinctive contribution on all of these points. It creates a diﬀerent opportunity for families to seek and receive support, through allocating practitioners to work individually and separately with both parents. It takes a trauma-informed approach to address the mental health needs of parents and babies. It underlines that the call to recognise and support child victims of domestic abuse must include babies, who are particularly aﬀected from pregnancy until the age of two. This is because of how domestic abuse can aﬀect the development of babies’ brains, bodies and relationships with their parents over that timescale.\ud \ud The academic evaluation report includes evidence from practitioners, stakeholders and a sample of parents who agreed to be interviewed up to three times during the course of the evaluation (2015 – 2019) and provides extensive data including validated research assessments. The four-year evaluation aimed to assess the feasibility, acceptability and impact of For Baby’s Sake as well as provide lessons for future research.\ud \ud Having stated the extent and profound risks and impact of the experience of DVA for parents and children during the perinatal period (conception to age two) and beyond, and having conducted a systematic evidence review, the report recognises that For Baby’s Sake is the first programme to address key limitations of existing interventions. The programme is at the vanguard of the move towards whole-family, trauma-informed approaches.\ud \ud For Baby’s Sake takes a unique approach, with practitioners working individually and separately with both parents, from pregnancy, combining evidence-based elements to break cycles of DVA, address the impact of parents’ own childhood trauma and improve adult mental health, alongside parenting interventions focused on infant mental health and parent-infant attachment.\ud \ud Results of the evaluation show the successful embedding of For Baby’s Sake in its first two diverse prototype sites (Stevenage, North Herts and Welwyn Hatfield districts of Hertfordshire and London Three Boroughs - Westminster, Kensington & Chelsea and Hammersmith & Fulham). Across both sites, the programme received referrals, particularly from children’s social care, and attracted both co-parents to engage, demonstrating the feasibility of this novel aspect of the model, and sustained this engagement, with only 18% and 11% of all those referred disengaging following sign-up in Hertfordshire and London Three Boroughs respectively.\ud \ud Those engaged in For Baby’s Sake, and recruited to the evaluation, had complex interpersonal abuse histories. There were challenges for service users in reporting on their experience and perpetration of domestic abuse, which included reports of bi-directional abuse in some relationships. The evaluation found that at their first, baseline interview, many service users did not acknowledge experiencing DVA or using DVA behaviours within the previous year, though they were much more likely to disclose that there had been domestic abuse at some time in the relationship. Almost all mothers also reported that they had experienced abuse at some stage from someone other than their co-parent. At the second interview, they were more likely to disclose experiencing abuse or using abusive behaviours. Evidence suggests that the initial low reports of abuse may be due to minimisation, to not recognising certain behaviours as abusive or to reluctance to disclose due to fear or shame. Qualitative data indicate how the therapeutic work could have aﬀected disclosure of abuse, by enabling mothers to understand domestic abuse more clearly and link that knowledge to their experience.\ud \ud Service user interviews pointed to their multiple, complex needs, indicating the success of For Baby’s Sake in reaching its target population. A substantial proportion of men and women had symptoms of depression, anxiety and post-traumatic stress disorder (PTSD), as well as high numbers of disordered personality traits. As expected, the majority of parents reported adverse childhood experiences (ACEs), with many experiencing various forms of abuse and trauma and over half reporting that they experienced DVA as children.\ud \ud These childhood experiences link directly to one of the key reasons for expectant co-parents to engage in For Baby’s Sake. Many of the mothers and fathers explained how their motivation for change stemmed from their desire to provide a better life for their children and to be diﬀerent kinds of parents in order to prevent their children having the same upbringing as they did. Similarly, practitioners reflected that the central emphasis on the baby is crucial in engaging service users and in facilitating healthy parenting behaviours, leading to secure attachments.\ud \ud The voluntary nature of For Baby’s Sake, and the contrast with service users’ previous experience of interventions, also acted as a motivating factor. Parents felt that the voluntary approach meant they did not feel coerced into participating and found interactions with the For Baby’s Sake teams to be non- judgemental, inviting and welcoming.\ud \ud Mothers and fathers engaging in For Baby’s Sake were positive about the programme, with many describing how ithad exceeded their expectations. They were able to identify the impacts for them, their relationships and their children, and to explore their successes, including gaining confidence and recognising and challenging abusive behaviours. These learnings were perceived to resonate particularly among some women from minority ethnic backgrounds who described how certain cultural expectations could create barriers to recognising domestic abuse and to speaking out against certain behaviours.\ud \ud The evaluation finds merit in the For Baby’s Sake approach ofsupporting parents whether together as a couple or not and making it clear that the programme has no goal in principle about parents staying together or separating. Each service user is supported and empowered to recognise and acton their own goals in this respect. The evaluation noted how these goals changed for some service users who expected to stay in the relationship but found personal growth instead.\ud \ud Over two thirds of women and all of the men interviewed for the evaluation were in a relationship with their co-parentatbaseline interviews. This reduced across time, with only a third of both men and women remaining in this relationship at the two-year follow-up. The researchers suggested that changes in the intimate relationship status with the co-parent can represent a useful assessment of the outcome of the programme.\ud \ud Mothers and fathers described how For Baby’s Sake had facilitated step- changes in their relationships with their babies and in their understanding of what parenting input babies need to develop. For the babies, birth and child developmentoutcomesatoneandtwoyears(includingbabies’ social, emotional and behavioural development) were largely in the normal range and only a third of families had any social care input at the two-year stage. This contrasted with 70% at baseline, of which 56% were either under a Child Protection Plan or Child in Need processes.\ud \ud Throughout the evaluation report, consistent messages about the mechanisms for change enabled by For Baby’s Sake were reflected by service users and practitioners alike. Parents talked about the value of the whole-family therapeutic approach, which provides support for the needs of the individual, within intimate and/or co-parenting relationships, and for the needs of the children. Parents are provided with tools and strategies to manage and improve their situations and feelings, including learning about visualisation and mindfulness, practising time-outs and using an anger scale. Many fathers, in particular, reflected on how the therapeutic model allowed them space to acknowledge their own emotions and to use tools and develop methods to instil healthy coping mechanisms.\ud \ud Another key mechanism for change was identified as the ability to develop a close therapeutic relationship with a highly skilled practitioner over a long period of time. Practitioners reflected that they were able to focus in a detailed way on a specific member of the family, while working with their colleagues to develop a holistic picture of the issues for all members of the family and understand much better any risks and safeguarding issues.\ud \ud Many parents specifically identified the Inner Child module, the therapeutic core of For Baby’s Sake, as particularly beneficial, building trust and working therapeutically with practitioners to examine their childhoods through a trauma-informed lens. For mothers, the Inner Child module was reported as giving them time and space to explore diﬀerent aspects of their lives, process their childhood experiences and their experience of DVA as adults and build self-esteem and a sense of empowerment. For fathers, benefits were described in helping them to understand that what happened to them as a child was not their fault but that they were responsible for the behaviours and actions they engaged in as adults. This led to greater awareness among some fathers of the impact of their behaviour, a willingness to take responsibility for their actions, the commitment to no longer use violence and abuse and the desire to put the needs of their co-parents and children first.\ud \ud This shift ‘from being me-centred to child-centred’ describes practitioners’ and service users’ views thatplacing the baby atthe centre ofthe work and adopting a whole-family and co-parenting approach provide the best opportunity to aﬀect change in parents’ lives and improve children’s outcomes and safety. Many families spoke of the value in receiving psychoeducation on how DVA impacts on children and in receiving general parenting support. Parents identified their learning about child brain development and how attachments form as contributing to them becoming more confident in their parenting and improving communication in their family. Building on this, mothers and fathers who took part in Video Interaction Guidance (VIG) within the programme perceived it had helped them to focus on attachment and sensitive, attuned parenting, allowing them to see the bonds they had developed with their child and providing reassurance about their parenting abilities.\ud \ud The researchers interviewed multi-agency professionals in Hertfordshire and London who reported on their views of For Baby’s Sake and their experience of working with the teams. They valued the holistic, whole family approach, endorsed the programme for being evidence-based and reported that the For Baby’s Sake teams were highly trained, skilled and responsive. Stakeholders described eﬀective joint working practices and communication, with children’s social care and health in particular, citing how this would result in collaborative working around the safeguarding of children and families.\ud \ud The evaluation also described how dialogue between For Baby’s Sake and local stakeholders helped to build and strengthen understanding of the programme and encouraged this dialogue to continue at local and national levels.\ud \ud The evaluation report also provides valuable learning about the research process itself, concluding that it is feasible and acceptable to collect quantitative and qualitative data through a range of self-report, observational, staﬀ and researcher-administered measures. These data can be collected from all family members among this cohort of families with multiple complex needs and intergenerational trauma histories, although data collection, from fathers in particular, across multiple time points can be challenging. Realist research methodologies that use qualitative and quantitative techniques to examine what works best for whom, when and in what context, are suggested for use in future evaluation, to suit the holistic and continuously developing nature of For Baby’s Sake. Undertaking longer-term follow-up of those engaged in prototype For Baby’s Sake sites and the introduction of a comparator group who receive standard support are encouraged for consideration in any future evaluation of the eﬀectiveness of For Baby’s Sake. The evaluation team suggests further research is required with a larger sample in order to undertake a full economic evaluation of the programme.\ud \ud Finally, the report includes many insights and ideas to consider as the Stefanou Foundation and its partners continue to develop and roll-out For Baby’s Sake beyond its (now four) delivery sites. These include:\ud \ud • Development of an assessment of fidelity using key principles of For Baby’s Sake rather than adherence to specific elements of the programme manual, to reflect the flexibility now embedded within the programme that enables the match with service users’ needs and circumstances\ud \ud • Drawing on feedback about language and messaging to ensure the programme’s approach is well understood. For example, guarding against ‘victim’ and ‘perpetrator’ terminology which fathers found to be blaming, providing assurance to mothers about the programme’s approach to supporting one parent when the other parent disengages, and clarifying to stakeholders that the programme is not prescriptive about models of co- parenting\ud \ud • Developing a new outcome assessment to measure changes to the relationship status of co-parents throughout the programme, alongside indicators regarding not only practitioners’ assessment of risk but also parents’ perceptions of safety and risk of harm, both for themselves and for their children, to indicate the success of the programme\ud \ud • Providing training to local authorities and sharing learning from For Baby’s Sake more widely, including on adopting trauma-informed approaches to all of the factors (individual, family/personal relationships, communities and societal) that can contribute to domestic abuse and make it challenging to break the cycle\ud \ud • Finding new ways to examine the full range of outcomes achieved by families, reflecting the diﬃculty of applying quantitative measures to assess outcomes for families and longer-term outcomes for children. This would build on the Foundation’s move to incorporate more qualitative approaches that describe families’ journeys through For Baby’s Sake as a way to ‘show the true impact’ in addition to quantitative measures\ud \ud The evaluation has confirmed that For Baby’s Sake is the first programme to fill an important gap in provision through its unique approach. This early research evaluation into the prototype phase found that the majority of individuals who engaged in the evaluation and remained in the programme over time reported a positive experience, were able to identify specific ways that they had changed their behaviour and related these to aspects of the programme. These findings, alongside the recognition by the evaluation team of the importance of the innovation and the careful, evidence-based approach of the Foundation in creating and operating the programme, support the creation of two new sites in Cambridgeshire and Blackpool in 2019 and early 2020 respectively, and will contribute to the case for further expansion of For Baby’s Sake. The Stefanou Foundation is keen to work with partners to achieve this expansion, to reach more families, break the cycle of domestic abuse and give babies the best start in life.
Published: 2020

6. Prevalence of experiences of domestic violence among psychiatric patients: systematic review

Author: Oram, S., Trevillion, K., Feder, G., and Howard, L. M.
Published: 2013

7. Domestic violence and severe psychiatric disorders: prevalence and interventions

Author: Howard, L. M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., and Feder, G.
Published: 2010

8. Probability of major depression classification based on the SCID, CIDI, and MINI diagnostic interviews: A synthesis of three individual participant data meta-analyses

Author: Wu, Y. Levis, B. Ioannidis, J.P.A. Benedetti, A. Thombs, B.D. Sun, Y. He, C. Krishnan, A. Bhandari, P.M. Neupane, D. Negeri, Z. Imran, M. Rice, D.B. Riehm, K.E. Saadat, N. Azar, M. Levis, A.W. Sanchez, T.A. Chiovitti, M.J. Yan, X.W. Boruff, J. Kloda, L.A. Cuijpers, P. Gilbody, S. McMillan, D. Patten, S.B. Shrier, I. Ziegelstein, R.C. Comeau, L. Mitchell, N.D. Tonelli, M. Vigod, S.N. Henry, M. Ismail, Z. Loiselle, C.G. Akena, D.H. Al-Adawi, S. Alamri, S.H. Alvarado, R. Alvarado-Esquivel, C. Amtmann, D. Arroll, B. Ayalon, L. Bakare, M.O. Baradaran, H.R. Barnes, J. Bavle, A.D. Beck, C.T. Beraldi, A. Bernstein, C.N. Bhana, A. Bindt, C. Bombardier, C.H. Boyce, P.M. Büel-Drabe, N. Buji, R.I. Bunevicius, A. Butnoriene, J. Bunevicius, R. Butterworth, P. Carter, G. Chagas, M.H. Chan, J.C.N. Chan, L.F. Chaudron, L.H. Chen, C.-K. Cholera, R. Clover, K. Conroy, R.M. Conway, A. Conwell, Y. Correa, H. Castro E Couto, T. Cukor, D. Dabscheck, E. Daray, F.M. De Figueiredo, F.P. De Man-Van Ginkel, J.M. Diez-Quevedo, C. Douven, E. Downing, M.G. Eapen, V. Fann, J.R. Feinstein, A. Ferentinos, P.P. Fernandes, M. Field, S. Figueiredo, B. Fischer, F.H. Fisher, J.R.W. Flint, A.J. Fujimori, M. Fung, D.S.S. Gallagher, P. Gandy, M. Garcia-Esteve, L. Garman, E.C. Gelaye, B. Gholizadeh, L. Giardinelli, L. Gibson, L.J. Goodyear-Smith, F. Grassi, L. Green, E.P. Greeno, C.G. Hall, B.J. Hantsoo, L. Haroz, E.E. Harter, M. Hegerl, U. Helle, N. Hides, L. Hobfoll, S.E. Honikman, S. Howard, L.M. Hudson, M. Hyphantis, T. Inagaki, M. Jenewein, J. Jeon, H.J. Jette, N. Keller, M. Khalifa, D.S. Khamseh, M.E. Kiely, K.M. Kim, S.-W. Kjargaard, M. Kohler, S. Kohlhoff, J. Kohrt, B.A. Kozinszky, Z. Kusminskas, L. Kwan, Y. Lamers, F. Lara, M.A. Lelli, L. Leonardou, A.A. Levin-Aspenson, H.F. Lotrakul, M. Loureiro, S.R. Lowe, B. Luitel, N.P. Lund, C. Maes, M. Marrie, R.A. Marsh, L. Martin-Santos, R. Marx, B.P. Massardo, L. Matsuoka, Y. Mehner, A. Meuti, V. Michopoulos, I. Misery, L. Sidik, S.M. Munhoz, T.N. Muramatsu, K. Radoš, S.N. Nakku, J.E.M. Navarrete, L. Garcia, P.N. Navines, R. Nishi, D. O'Donnell, M.L. Luwa E-Andjafono, D.O. Osório, F.L. Öztürk, A. Peceliuniene, J. Pence, B.W. Persoons, P. Picardi, A. Pintor, L. Ponsford, J.L. Pugh, S.L. Quinn, T.J. Rancans, E. Rathod, S.D. Reme, S.E. Reuter, K. Robertson-Blackmore, E. Rochat, T.J. Rooney, A.G. Rowe, H.J. Sánchez-González, R. Santos, I.S. Schram, M.T. Schwarzbold, M.L. Cankorur, V.S. Shaaban, J. Sharpe, L. Shinn, E.H. Sidebottom, A. Simard, S. Simning, A. Singer, S. Siu, B.W.M. Skalkidou, A. Spangenberg, L. Stafford, L. Stein, A. Stewart, R.C. Stone, J. Su, K.-P. Sultan, S. Sundström-Poromaa, I. Sung, S.C. Suzuki, K. Tadinac, M. Tan, P.L.L. Tandon, S.D. Taylor-Rowan, M. Teixeira, A.L. Tendais, I. Thiagayson, P. Tiringer, I. Töreki, A. Torres-Giménez, A. Tran, T.D. Trevillion, K. Tung, K.-Y. Turner, A. Turner, K. Van Der Feltz-Cornelis, C.M. Van Heyningen, T. Van Weert, H.C. Vega-Dienstmaier, J.M. Vöhringer, P.A. Wagner, L.I. Walterfang, M. Wang, J.L. Wang, W. Wang, L.-J. White, J. Wong, D.K. Wynter, K. Yamada, M. Yonkers, K.A. Zeng, Q.Z. Zhang, Y. DEPRESsion Screening Data (DEPRESSD) Collaboration
Abstract: Introduction: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. Objective: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. Methods: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79-1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52-0.80). Conclusions: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics. © 2020
Published: 2020

9. Assessing the Acceptability, Feasibility and Sustainability of an Intervention to Increase Detection of Domestic Violence and Abuse in Patients Suffering From Severe Mental Illness: A Qualitative Study

Author: Ruijne, R.E., Kamperman, A.M. (Astrid), Trevillion, K., Garofalo, C., Gaag, M. van der, Zarchev, M., Bogaerts, S. (Stefan), Howard, L.M., Mulder, C.L. (Niels), Ruijne, R.E., Kamperman, A.M. (Astrid), Trevillion, K., Garofalo, C., Gaag, M. van der, Zarchev, M., Bogaerts, S. (Stefan), Howard, L.M., and Mulder, C.L. (Niels)
Abstract: Rationale: Despite interventions to improve detection rates, domestic violence, and abuse (DVA) remains largely undetected by healthcare services. We therefore aimed to examine the acceptability, feasibility, and sustainability of an intervention aiming to improve DVA detection rates, which included a clear referral pathway (i.e., the BRAVE intervention) and to explore the acceptability and feasibility of DVA management and referrals in general, in the context of low detection rates. Methods: Qualitative study design with four focus groups of 16 community mental health (CMH) clinicians from both control and intervention arms. The focus groups discussed managing DVA in clinical practice and staff experiences with the BRAVE intervention in particular. Focus groups continued until saturation of the subject was reached. Interviews were analyzed using a thematic analysis approach. Results: DVA was seen to be highly relevant to mental healthcare but is also a very sensitive subject. Barriers in CMH professionals, institutions, and society meant CMH professionals often refrained from asking about DVA in patients. Barriers included communication difficulties between CMH professionals and DVA professionals, a fear of disrupting the therapeutic alliance with the patient, and a lack of appropriate services to help victims of DVA. Conclusion: The BRAVE intervention was acceptable but not feasible or sustainable. Personal, institutional, and public barriers make it not feasible for CMH professionals to detect DVA in mental healthcare. To increase the detection of DVA, professional standards should be combined with training, feedback sessions with peers and DVA counselors, and routine enquiry about DVA.
Published: 2020
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10. 'We have to put the fire out first before we start rebuilding the house': practitioners' experiences of supporting women with histories of substance use, interpersonal abuse and symptoms of post-traumatic stress disorder

Author: Bailey, K, Trevillion, K, Gilchrist, G, Bailey, K, Trevillion, K, and Gilchrist, G
Published: 2020

11. The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review

Author: Edward, K-L, Stefanidou, T, Hughes, E, Kester, K, Edmondson, A, Majeed-Ariss, R, Smith, C, Ariss, S, Brooker, C, Gilchrist, G, Kendal, S, Lucock, M, Maxted, F, Perot, C, Shallcross, R, Trevillion, K, Lloyd-Evans, B, Edward, K-L, Stefanidou, T, Hughes, E, Kester, K, Edmondson, A, Majeed-Ariss, R, Smith, C, Ariss, S, Brooker, C, Gilchrist, G, Kendal, S, Lucock, M, Maxted, F, Perot, C, Shallcross, R, Trevillion, K, and Lloyd-Evans, B
Abstract: BACKGROUND: Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice. METHODS: A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted. RESULTS: We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counsel
Published: 2020

12. Assessing the Acceptability, Feasibility and Sustainability of an Intervention to Increase Detection of Domestic Violence and Abuse in Patients Suffering From Severe Mental Illness: A Qualitative Study

Author: Ruijne, Roos, Kamperman, Astrid, Trevillion, K, Garofalo, C, Gaag, M, Zarchev, M, Bogaerts, S, Howard, LM, Mulder, Niels, Ruijne, Roos, Kamperman, Astrid, Trevillion, K, Garofalo, C, Gaag, M, Zarchev, M, Bogaerts, S, Howard, LM, and Mulder, Niels
Published: 2020

13. Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis

Author: Levis, B, McMillan, D, Sun, Y, He, C, Rice, DB, Krishnan, A, Wu, Y, Azar, M, Sanchez, TA, Chiovitti, MJ, Bhandari, PM, Neupane, D, Saadat, N, Riehm, KE, Imran, M, Boruff, JT, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, Patten, SB, Shrier, I, Ziegelstein, RC, Comeau, L, Mitchell, ND, Tonelli, M, Vigod, SN, Aceti, F, Alvarado, R, Alvarado-Esquivel, C, Bakare, MO, Barnes, J, Beck, CT, Bindt, C, Boyce, PM, Bunevicius, A, Couto, TCE, Chaudron, LH, Correa, H, de Figueiredo, FP, Eapen, V ; https://orcid.org/0000-0001-6296-8306, Fernandes, M, Figueiredo, B, Fisher, JRW, Garcia-Esteve, L, Giardinelli, L, Helle, N, Howard, LM, Khalifa, DS, Kohlhoff, J ; https://orcid.org/0000-0001-6202-6685, Kusminskas, L, Kozinszky, Z, Lelli, L, Leonardou, AA, Lewis, BA, Maes, M, Meuti, V, Nakić Radoš, S, Navarro García, P, Nishi, D, Okitundu Luwa E-Andjafono, D, Robertson-Blackmore, E, Rochat, TJ, Rowe, HJ, Siu, BWM, Skalkidou, A, Stein, A, Stewart, RC, Su, KP, Sundström-Poromaa, I, Tadinac, M, Tandon, SD, Tendais, I, Thiagayson, P, Töreki, A, Torres-Giménez, A, Tran, TD, Trevillion, K, Turner, K, Vega-Dienstmaier, JM, Wynter, K, Yonkers, KA, Benedetti, A, Thombs, BD, Levis, B, McMillan, D, Sun, Y, He, C, Rice, DB, Krishnan, A, Wu, Y, Azar, M, Sanchez, TA, Chiovitti, MJ, Bhandari, PM, Neupane, D, Saadat, N, Riehm, KE, Imran, M, Boruff, JT, Cuijpers, P, Gilbody, S, Ioannidis, JPA, Kloda, LA, Patten, SB, Shrier, I, Ziegelstein, RC, Comeau, L, Mitchell, ND, Tonelli, M, Vigod, SN, Aceti, F, Alvarado, R, Alvarado-Esquivel, C, Bakare, MO, Barnes, J, Beck, CT, Bindt, C, Boyce, PM, Bunevicius, A, Couto, TCE, Chaudron, LH, Correa, H, de Figueiredo, FP, Eapen, V ; https://orcid.org/0000-0001-6296-8306, Fernandes, M, Figueiredo, B, Fisher, JRW, Garcia-Esteve, L, Giardinelli, L, Helle, N, Howard, LM, Khalifa, DS, Kohlhoff, J ; https://orcid.org/0000-0001-6202-6685, Kusminskas, L, Kozinszky, Z, Lelli, L, Leonardou, AA, Lewis, BA, Maes, M, Meuti, V, Nakić Radoš, S, Navarro García, P, Nishi, D, Okitundu Luwa E-Andjafono, D, Robertson-Blackmore, E, Rochat, TJ, Rowe, HJ, Siu, BWM, Skalkidou, A, Stein, A, Stewart, RC, Su, KP, Sundström-Poromaa, I, Tadinac, M, Tandon, SD, Tendais, I, Thiagayson, P, Töreki, A, Torres-Giménez, A, Tran, TD, Trevillion, K, Turner, K, Vega-Dienstmaier, JM, Wynter, K, Yonkers, KA, Benedetti, A, and Thombs, BD
Abstract: Objectives: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. Methods: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. Results: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. Conclusion: Different interviews may not classify major depression equivalently.
Published: 2019

14. Mental health professionals’ knowledge, skills and attitudes on domestic violence and abuse in the Netherlands: Cross-sectional study

Author: Ruijne, R.E., Kamperman, A.M., Trevillion, K., Garofalo, Carlo, Bogaerts, Stefan, Howard, L.M., Mulder, C.L., Ruijne, R.E., Kamperman, A.M., Trevillion, K., Garofalo, Carlo, Bogaerts, Stefan, Howard, L.M., and Mulder, C.L.
Abstract: Background Despite the high prevalence of domestic violence and abuse (DVA) among patients with psychiatric conditions, detection rates are low. Limited knowledge and skills on DVA in mental healthcare (MHC) professionals might contribute to poor identification.AimsTo assess the level of, and factors associated with, DVA knowledge and skills among MHC professionals. Method A total of 278 professionals in Dutch MHC institutions completed a survey assessing factual knowledge, perceived knowledge, perceived skills and attitudes about DVA. Results On average, low scores were reported for perceived skills and knowledge. MHC professionals in primary care scored higher than those working with individuals with severe mental illness (P<0.005). Levels of factual knowledge were higher; levels of attitudes moderate. Previous training was positively associated with skills (odds ratios (OR) = 3.0) and attitudes (OR = 2.7). Years of work was negatively associated with factual knowledge (OR = 0.97). Larger case-loads predicted higher scores on skills (OR = 2.1). Conclusions Training is needed, particularly for clinicians working with patients with severe mental illness.
Published: 2019

15. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy

Author: Howard, LM, Ryan, EG, Trevillion, K, Anderson, F, Bick, D, Bye, A, Byford, S, O'Connor, S, Sands, P, Demilew, J, Milgrom, J, Pickles, A, Howard, LM, Ryan, EG, Trevillion, K, Anderson, F, Bick, D, Bye, A, Byford, S, O'Connor, S, Sands, P, Demilew, J, Milgrom, J, and Pickles, A
Abstract: BACKGROUND: There is limited evidence on the prevalence and identification of antenatal mental disorders. Aims To investigate the prevalence of mental disorders in early pregnancy and the diagnostic accuracy of depression-screening (Whooley) questions compared with the Edinburgh Postnatal Depression Scale (EPDS), against the Structured Clinical Interview DSM-IV-TR. METHOD: Cross-sectional survey of women responding to Whooley questions asked at their first antenatal appointment. Women responding positively and a random sample of women responding negatively were invited to participate. RESULTS: Population prevalence was 27% (95% CI 22-32): 11% (95% CI 8-14) depression; 15% (95% CI 11-19) anxiety disorders; 2% (95% CI 1-4) obsessive-compulsive disorder; 0.8% (95% CI 0-1) post-traumatic stress disorder; 2% (95% CI 0.4-3) eating disorders; 0.3% (95% CI 0.1-1) bipolar disorder I, 0.3% (95% CI 0.1-1%) bipolar disorder II; 0.7% (95% CI 0-1) borderline personality disorder. For identification of depression, likelihood ratios were 8.2 (Whooley) and 9.8 (EPDS). Diagnostic accuracy was similar in identifying any disorder (likelihood ratios 5.8 and 6). CONCLUSIONS: Endorsement of Whooley questions in pregnancy indicates the need for a clinical assessment of diagnosis and could be implemented when maternity professionals have been appropriately trained on how to ask the questions sensitively, in settings where a clear referral and care pathway is available. Declaration of interest L.M.H. chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012-2014.
Published: 2018

16. Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

Author: Nath, S, Ryan, EG, Trevillion, K, Bick, D, Demilew, J, Milgrom, J, Pickles, A, Howard, LM, Nath, S, Ryan, EG, Trevillion, K, Bick, D, Demilew, J, Milgrom, J, Pickles, A, and Howard, LM
Abstract: OBJECTIVE: To estimate the population prevalence of anxiety disorders during pregnancy and investigate the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2) for a) GAD and b) any anxiety disorder. DESIGN: Cross-sectional survey using a stratified sampling design. Sampling weights were used in the analysis to adjust for the bias introduced by the stratified sampling. SETTING: Inner-city maternity service, South London. PARTICIPANTS: 545 pregnant women were interviewed after their first antenatal appointment; 528 provided answers on the GAD-2 questions. MAIN OUTCOME MEASURES: Diagnosis generated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID). RESULTS: Population prevalence of anxiety disorders was 17% (95% CI 12% to 21%): 5% (95% CI 3% to 6%) for GAD, 4% (95% CI 2% to 6%) for social phobia, 8% (95% CI 5% to 11%) for specific phobia and 2% (95% CI 1% to 4%) for obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) prevalence was unclear due to higher levels of reluctance to respond to PTSD interview questions but sensitivity analyses suggest population prevalence maybe up to 4% (95% CI 2% to 6%). Weighted sensitivity of GAD-2 for GAD (cut-off ≥3) was 69%, specificity 91%, positive predictive value 26%, negative predictive value 98% and likelihood ratio 7.35. For any anxiety disorder the weighted sensitivity was 26%, specificity 91%, positive predictive value 36%, negative predictive value 87% and likelihood ratio 2.92. CONCLUSIONS: Anxiety disorders are common but GAD-2 generates many false positives and may therefore be unhelpful in maternity services.
Published: 2018

17. Detection of domestic violence by community mental health teams: A multi-center, cluster randomized controlled trial

Author: Ruijne, R.E. (Roos E.), Howard, L.M. (Louise M.), Trevillion, K. (Kylee), Jongejan, F.E. (Femke E.), Garofalo, C. (Carlo), Bogaerts, S. (Stefan), Mulder, C.L. (Niels), Kamperman, A.M. (Astrid), Ruijne, R.E. (Roos E.), Howard, L.M. (Louise M.), Trevillion, K. (Kylee), Jongejan, F.E. (Femke E.), Garofalo, C. (Carlo), Bogaerts, S. (Stefan), Mulder, C.L. (Niels), and Kamperman, A.M. (Astrid)
Abstract: Background: Domestic Violence and Abuse (DVA) is associated with a range of psychosocial and mental health problems. Having a psychiatric illness increases likelihood of being a victim of DVA. Despite the evidence of a high risk for DVA and the serious effects of violent victimization in psychiatric patients, detection rates are low and responses are inadequate. The aim of the BRAVE (Better Reduction trough Assessment of Violence and Evaluation) study is to improve detection of and response to DVA in psychiatric patients. In this article, we present the protocol of the BRAVE study which follows the SPIRIT guidelines. Methods: The BRAVE study is a cluster randomized controlled trial. We will include 24 community mental health teams from Rotterdam and The Hague. Twelve teams will provide care as usual and 12 teams will receive the intervention. The intervention consists of 1) a knowledge and ski
Published: 2017
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18. Detection of domestic violence by community mental health teams: a multicenter, cluster randomized controlled trial

Author: Ruijne, Roos, Howard, LM, Trevillion, K, Jongejan, FE, Garofalo, C, Bogaerts, S, Mulder, Niels, Kamperman, AM, Ruijne, Roos, Howard, LM, Trevillion, K, Jongejan, FE, Garofalo, C, Bogaerts, S, Mulder, Niels, and Kamperman, AM
Published: 2017

19. Detection of domestic violence by community mental health teams: A multicenter, cluster randomized controlled trial

Author: Ruijne, R.E., Howard, L.M., Trevillion, K., Jongejan, F.E., Garofalo, C., Bogaerts, S., Mulder, N.L., Kamperman, A., Ruijne, R.E., Howard, L.M., Trevillion, K., Jongejan, F.E., Garofalo, C., Bogaerts, S., Mulder, N.L., and Kamperman, A.
Abstract: Domestic Violence and Abuse (DVA) is associated with a range of psychosocial and mental health problems. Having a psychiatric illness increases likelihood of being a victim of DVA. Despite the evidence of a high risk for DVA and the serious effects of violent victimization in psychiatric patients, detection rates are low and responses are inadequate. The aim of the BRAVE (Better Reduction trough Assessment of Violence and Evaluation) study is to improve detection of and response to DVA in psychiatric patients. In this article, we present the protocol of the BRAVE study which follows the SPIRIT guidelines.
Published: 2017

20. Depression: an exploratory parallel-group randomised controlled trial of Antenatal guided self help for WomeN (DAWN): study protocol for a randomised controlled trial

Author: Trevillion, K, Domoney, J, Pickles, A, Bick, D, Byford, S, Heslin, M, Milgrom, J, Mycroft, R, Pariante, C, Ryan, E, Hunter, M, Howard, LM, Trevillion, K, Domoney, J, Pickles, A, Bick, D, Byford, S, Heslin, M, Milgrom, J, Mycroft, R, Pariante, C, Ryan, E, Hunter, M, and Howard, LM
Abstract: BACKGROUND: Depression is a common antenatal mental disorder and is associated with an increased risk of adverse effects on the fetus and significant morbidity for the mother; if untreated it can also continue into the post-natal period and affect mother-infant interactions. There has been little research evaluating the effectiveness or cost-effectiveness of antenatal psychological interventions for antenatal depression, particularly for mild to moderate disorders. International guidelines recommend a stepped care approach starting with Guided Self Help, and the aim of this exploratory trial is to investigate Guided Self Help modified for pregnancy. METHODS: The DAWN trial is an exploratory randomised controlled trial of the effectiveness and cost-effectiveness of antenatal Guided Self Help, modified for pregnancy and delivered by National Health Service Psychological Wellbeing Practitioners. Antenatal Guided Self Help, in addition to usual care, is compared with usual care for pregnant women diagnosed with mild to moderate depression and mixed anxiety and depression, using the Structured Clinical Interview for DSM-IV Disorders. Modifications for pregnancy include perinatal mental health training, addressing pregnancy-specific worries and including sections on health issues in pregnancy and planning for parenthood. Women allocated to Guided Self Help will be seen for up to eight sessions by a Psychological Wellbeing Practitioner (including an initial assessment session); there will also be an appointment at 12 weeks after delivery. Research measures including the Edinburgh Postnatal Depression Scale (primary outcome) and other measures of depression, anxiety, quality of life and service use will be collected from women before random allocation, 14 weeks after random allocation and at 12 weeks after delivery. Potential psychological mechanisms of the intervention will be explored using the Pregnancy-Related Thoughts Questionnaire and the Metacognitive Awareness Quest
Published: 2016

21. Disclosure of domestic violence in mental health settings: A qualitative meta-synthesis

Author: Trevillion, K, Hughes, B, Feder, G, Borschmann, R, Oram, S, Howard, LM, Trevillion, K, Hughes, B, Feder, G, Borschmann, R, Oram, S, and Howard, LM
Abstract: Little is known about how psychiatric services respond to service users' experiences of domestic violence. This qualitative meta-synthesis examined the healthcare experiences and expectations of mental health service users experiencing domestic violence. Twenty-two biomedical, social science, grey literature databases and websites were searched, supplemented by citation tracking and expert recommendations. Qualitative studies which included mental health service users (aged ≥ 16 years) with experiences of domestic violence were eligible for inclusion. Two reviewers independently extracted data from included papers and assessed quality. Findings from primary studies were combined using meta-synthesis techniques. Twelve studies provided data on 140 female and four male mental health service users. Themes were generally consistent across studies. Overarching theoretical constructs included the role of professionals in identifying domestic violence and facilitating disclosures, implementing personalized care and referring appropriately. Mental health services often failed to identify and facilitate disclosures of domestic violence, and to develop responses that prioritized service users' safety. Mental health services were reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness and the dominance of the biomedical model and stigma of mental illness were found to inhibit effective responses. Mental health services often fail to adequately address the violence experienced by mental health service users. This meta-synthesis highlights the need for mental health services to establish appropriate strategies and responses to domestic violence to ensure optimal care of this vulnerable population.
Published: 2014

22. Perpetration of Intimate Partner Violence by People with Mental Illness

Author: Oram, S, primary, Khalifeh, H, additional, Trevillion, K, additional, Feder, G, additional, and Howard, LM, additional
Published: 2014
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23. Systematic review and meta-analysis of psychiatric disorder and the perpetration of partner violence

Author: Oram, S., primary, Trevillion, K., additional, Khalifeh, H., additional, Feder, G., additional, and Howard, L.M., additional
Published: 2013
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24. Linking abuse and recovery through advocacy: an observational study

Author: Trevillion, K., primary, Byford, S., additional, Cary, M., additional, Rose, D., additional, Oram, S., additional, Feder, G., additional, Agnew-Davies, R., additional, and Howard, L. M., additional
Published: 2013
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25. 829 – Domestic violence and mental disorders

Author: Howard, L., primary, Oram, S., additional, Trevillion, K., additional, and Feder, G., additional
Published: 2013
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26. The response of mental health services to domestic violence

Author: Trevillion, K, primary, Rose, D, additional, Feder, G, additional, Morgan, C, additional, Woodall, A, additional, and Howard, L, additional
Published: 2011
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27. A domestic violence intervention for mental health services: a pilot study

Author: Trevillion, K, primary, Feder, G, additional, Agnew-Davies, R, additional, Byford, S, additional, Rose, D, additional, and Howard, L, additional
Published: 2011
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28. Domestic violence and severe psychiatric disorders: prevalence and interventions

Author: Howard, L. M., primary, Trevillion, K., additional, Khalifeh, H., additional, Woodall, A., additional, Agnew-Davies, R., additional, and Feder, G., additional
Published: 2009
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29. Systematic review and meta-analysis of psychiatric disorder and the perpetration of partner violence.

Author: Oram, S., Trevillion, K., Khalifeh, H., Feder, G., and Howard, L.M.
Published: 2015
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30. Systematic review and meta-analysis of psychiatric disorder and the perpetration of partner violence

Author: Oram, S., Trevillion, K., Khalifeh, H., Feder, G., and Howard, L.M.
Abstract: Backgrounds.The extent to which psychiatric disorders are associated with an increased risk of violence to partners is unclear. This review aimed to establish risk of violence against partners among men and women with diagnosed psychiatric disorders.Methods.Systematic review and meta-analysis. Searches of eleven electronic databases were supplemented by hand searching, reference screening and citation tracking of included articles, and expert recommendations.Results.Seventeen studies were included, reporting on 72 585 participants, but only three reported on past year violence. Pooled risk estimates could not be calculated for past year violence against a partner and the three studies did not consistently report increased risk for any diagnosis. Pooled estimates showed an increased risk of having ever been physically violent towards a partner among men with depression (odds ratio (OR) 2.8, 95% confidence intervals (CI) 2.5–3.3), generalized anxiety disorder (GAD) (OR 3.2, 95% CI 2.3–4.4) and panic disorder (OR 2.5, 95% CI C% 1.7–3.6). Increased risk was also found among women with depression (OR 2.4, 95% CI 2.1–2.8), GAD (OR 2.4, 95% CI 1.9–3.0) and panic disorder (OR 1.9, 95% CI 1.4–2.5).Conclusions.Psychiatric disorders are associated with high prevalence and increased odds of having ever been physically violent against a partner. As history of violence is a predictor of current violence, mental health professionals should ask about previous partner violence when assessing risk.
Published: 2014
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31. Linking abuse and recovery through advocacy: an observational study

Author: Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G., Agnew-Davies, R., and Howard, L. M.
Abstract: Aims.High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a future cluster randomized controlled trial.Methods.Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and two control teams). The intervention comprised domestic violence training for clinicians' and referral to domestic violence advocacy for service users. Clinicians' (n= 29) domestic violence knowledge, attitudes and behaviours were assessed before and 6 months post-training. Service users' (n= 34) safety behaviours, unmet needs, quality of life and frequency/severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected.Results.Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, attitudes and behaviours at follow-up (p< 0.05). Service users receiving the intervention reported significant reductions in violence (p< 0.001) and unmet needs at follow-up (p< 0.05).Conclusions.Interventions comprising domestic violence training for clinicians and referral to domestic violence advocacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation are needed.
Published: 2014
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32. Domestic violence: responding to the needs of patients.

Author: Trevillion, K
Abstract: Victims of domestic violence have increased contact with healthcare services, but may not always be identified as experiencing abuse. Guidelines advocate that healthcare professionals should enquire about abuse and receive training on how to respond appropriately to any disclosures. This article examines how improved identification and response to domestic violence by healthcare staff can improve care for patients. [ABSTRACT FROM AUTHOR]
Published: 2011
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33. Routine enquiry for domestic violence is not enough

Author: Howard, L. M. and Trevillion, K.
Published: 2011
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34. Barriers and facilitators to accessing sexual and reproductive health services for people with severe mental illness: a systematic review.

Author: Brown M, Tassie E, Carlisle S, Covshoff E, Ronaldson A, Williams J, Smith S, Trevillion K, Hughes E, and Heslin M
Abstract: Purpose: Despite increased prevalence of sexual and reproductive health problems among people with severe mental illness (SMI), uptake of sexual and reproductive healthcare in this group is poor. The reasons for this are unclear. Therefore, this review aimed to identify the barriers and facilitators to accessing sexual and reproductive health services from a service user perspective., Methods: Three electronic databases were searched using key words for "sexual health" and "SMI". Data were screened and extracted by two independent reviewers. The Joanna Briggs Institute Critical Appraisal Tools were used to assess quality of included studies., Results: Five studies were included and underwent a narrative synthesis. They were on access to HIV care (n2), access to family planning methods (n2) and access to general sexual healthcare (n1). Barriers relating to HIV care included cost; barriers relating to family planning included lack of awareness and not considering the issue; barriers to general sexual healthcare included psychotic symptoms, mental health prioritisation, stigma, lack of sexual health focus in mental health programs, difficulty initiating conversations, knowledge, culture/religion/ethnicity, and finances., Conclusions: Studies which examined access to HIV and family planning services did so in a way that limited participant responses. While only one study examined barriers and facilitators to accessing generic sexual health services, it did so robustly, although it focussed solely on young women and provided limited data on facilitators. Future work should focus on examining barriers, and facilitators, to accessing sexual healthcare in all people with SMI to better identify and address these challenges. PROSPERO ID CRD42023414740., Competing Interests: Declarations. Conflict of interest: MH, EC, KT and EH report funding from NIHR. AR reports funding from MQ Mental Health Charity. No other authors reported competing interests., (© 2025. The Author(s).)
Published: 2025
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35. Approaches to improving mental healthcare for autistic people: systematic review.

Author: Loizou S, Pemovska T, Stefanidou T, Foye U, Cooper R, Kular A, Greenburgh A, Baldwin H, Griffiths J, Saunders KRK, Barnett P, Minchin M, Brady G, Ahmed N, Parker J, Chipp B, Olive RR, Jackson R, Timmerman A, Sapiets S, Driskell E, Parsons B, Spain D, Totsika V, Mandy W, Pender R, Clery P, Trevillion K, Lloyd-Evans B, Simpson A, and Johnson S
Abstract: Background: Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people., Aims: To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness., Method: A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach., Results: A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions., Conclusion: Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.
Published: 2024
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36. The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence.

Author: Spaducci G, Oram S, Thiara R, Robson D, Peeren S, Gibbs A, and Trevillion K
Subjects: Female, Humans, Ethnicity psychology, Racial Groups, Minority Groups, Mental Health, Sex Offenses psychology, Sex Offenses ethnology, Substance-Related Disorders ethnology, Substance-Related Disorders psychology, Substance-Related Disorders therapy
Abstract: The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence., (© 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)
Published: 2024
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37. Cohort profile: The Social media, smartphone use and Self-harm in Young People (3S-YP) study-A prospective, observational cohort study of young people in contact with mental health services.

Author: Bye A, Carter B, Leightley D, Trevillion K, Liakata M, Branthonne-Foster S, Cross S, Zenasni Z, Carr E, Williamson G, Vega Viyuela A, and Dutta R
Subjects: Humans, Adolescent, Male, Female, Prospective Studies, Young Adult, Adult, Mental Health Services, Anxiety epidemiology, Surveys and Questionnaires, Depression epidemiology, Self Report, England epidemiology, Cohort Studies, Social Media, Self-Injurious Behavior epidemiology, Self-Injurious Behavior psychology, Smartphone
Abstract: Objectives: The Social media, Smartphone use and Self-Harm (3S-YP) study is a prospective observational cohort study to investigate the mechanisms underpinning associations between social media and smartphone use and self-harm in a clinical youth sample. We present here a comprehensive description of the cohort from baseline data and an overview of data available from baseline and follow-up assessments., Methods: Young people aged 13-25 years were recruited from a mental health trust in England and followed up for 6 months. Self-report data was collected at baseline and monthly during follow-up and linked with electronic health records (EHR) and user-generated data., Findings: A total of 362 young people enrolled and provided baseline questionnaire data. Most participants had a history of self-harm according to clinical (n = 295, 81.5%) and broader definitions (n = 296, 81.8%). At baseline, there were high levels of current moderate/severe anxiety (n = 244; 67.4%), depression (n = 255; 70.4%) and sleep disturbance (n = 171; 47.2%). Over half used social media and smartphones after midnight on weekdays (n = 197, 54.4%; n = 215, 59.4%) and weekends (n = 241, 66.6%; n = 263, 72.7%), and half met the cut-off for problematic smartphone use (n = 177; 48.9%). Of the cohort, we have questionnaire data at month 6 from 230 (63.5%), EHR data from 345 (95.3%), social media data from 110 (30.4%) and smartphone data from 48 (13.3%)., Conclusion: The 3S-YP study is the first prospective study with a clinical youth sample, for whom to investigate the impact of digital technology on youth mental health using novel data linkages. Baseline findings indicate self-harm, anxiety, depression, sleep disturbance and digital technology overuse are prevalent among clinical youth. Future analyses will explore associations between outcomes and exposures over time and compare self-report with user-generated data in this cohort., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Published: 2024
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38. The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study - the MiMoS Study.

Author: Hughes E, Domoney J, Knights N, Price H, Rutsito S, Stefanidou T, Majeed-Ariss R, Papamichail A, Ariss S, Gilchrist G, Hunter R, Kendal S, Lloyd-Evans B, Lucock M, Maxted F, Shallcross R, Tocque K, and Trevillion K
Subjects: Adult, Humans, Anxiety, Cross-Sectional Studies, Mental Health, Systematic Reviews as Topic, Sex Offenses, Substance-Related Disorders epidemiology
Abstract: Background: Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed., Aim: To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres., Setting and Sample: Staff and adult survivors in English sexual assault referral centres and partner agency staff., Design: A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5)., Findings: There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants ( n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma., Limitations: The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic., Conclusions: People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have 'complex' needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault., Future Work: Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research ; Vol. 11, No. 21., Trial Registration: This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347.
Published: 2023
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39. A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care.

Author: Saunders KRK, McGuinness E, Barnett P, Foye U, Sears J, Carlisle S, Allman F, Tzouvara V, Schlief M, Vera San Juan N, Stuart R, Griffiths J, Appleton R, McCrone P, Rowan Olive R, Nyikavaranda P, Jeynes T, K T, Mitchell L, Simpson A, Johnson S, and Trevillion K
Subjects: Pregnancy, Humans, Female, Mental Health, Mental Health Services
Abstract: Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps., (© 2023. BioMed Central Ltd., part of Springer Nature.)
Published: 2023
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40. A survey and stakeholder consultation of Independent Domestic Violence Advisor (IDVA) programmes in English maternity services.

Author: Forbes C, Alderson H, Domoney J, Papamichail A, Berry V, McGovern R, Sevdalis N, Rankin J, Newburn M, Healey A, Easter A, Heslin M, Feder G, Hudson K, Wilson CA, Melendez-Torres GJ, Howard LM, and Trevillion K
Subjects: Humans, Female, Pregnancy, Pregnant People, Referral and Consultation, Surveys and Questionnaires, State Medicine, Domestic Violence prevention & control, Domestic Violence psychology
Abstract: Background: Healthcare-based Independent Domestic Violence Advisors (hIDVA) are evidence-based programmes that provide emotional and practical support to service users experiencing domestic abuse. hIDVA programmes are found to improve health outcomes for service users and are increasingly delivered across a range of healthcare settings. However, it is unclear how hIDVA programmes are implemented across maternity services and the key facilitators and barriers to their implementation. The aim of this study was to identify; how many English National Health Service (NHS) Trusts with maternity services have a hIDVA programme; which departments within the Trust they operate in; what format, content, and variation in hIDVA programmes exist; and key facilitators and barriers of implementation in maternity services., Methods: A national survey of safeguarding midwives (Midwives whose role specifically tasks them to protect pregnant women from harm including physical, emotional, sexual and financial harm and neglect) within all maternity services across England; descriptive statistics were used to summarise responses. A World Café event (a participatory method, which aims to create a café atmosphere to facilitate informal conversation) with 38 national key stakeholders to examine barriers and facilitators to hIDVA programme implementation., Results: 86/124 Trusts (69%) with a maternity service responded to the survey; 59(69%) of respondents reported that they had a hIDVA programme, and 47(55%) of the hIDVA programmes operated within maternity services. Key facilitators to implementation of hIDVA programmes included training of NHS staff about the hIDVA role and regular communication between Trust staff and hIDVA staff; hIDVA staff working directly from the Trust; co-creation of hIDVA programmes with experts by experience; governance and middle- and senior-management support. Key barriers included hIDVA staff having a lack of access to a private space for their work, insecure funding for hIDVA programmes and issues with recruitment and retention of hIDVA staff., Conclusions: Despite hIDVA programmes role in improving the health outcomes of service users experiencing domestic abuse, increased funding and staff training is needed to successfully implement hIDVA staff in maternity services. Integrated Care Board commissioning of acute and mental health trust services would benefit from ensuring hIDVA programmes and clinician DVA training are prioritised., (© 2023. The Author(s).)
Published: 2023
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41. Author's reply. RE: Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study.

Author: Trevillion K, Howard LM, Byford S, and Lever-Taylor B
Subjects: Infant, Female, Humans, Cost-Benefit Analysis, Hospitalization, Cost-Effectiveness Analysis, Mothers psychology, Mental Disorders therapy, Mental Disorders psychology
Published: 2023
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42. Co-producing rapid research: Strengths and challenges from a lived experience perspective.

Author: Machin K, Shah P, Nicholls V, Jeynes T, Tk, Trevillion K, and Vera San Juan N
Abstract: The Lived Experience Researchers (LERs) of the Mental Health Policy Research Unit (MHPRU) reflect on the experience of conducting rapid co-produced research, particularly during the first year of the COVID-19 pandemic. Throughout this perspective article, we introduce requirements for co-production applying the 4Pi Framework, reflect on specific characteristics of co-production in rapid research, discuss strengths and challenges for involvement of LERs in rapid research, and lastly provide recommendations to achieve meaningful involvement. Incorporating meaningful co-production is an augmentation to any research project, with several benefits to the research, to the team, and to individual researchers. Particularly in the case of rapid research, that aims for efficient translation of knowledge into practice, involvement of experts by experience will be key. The work conducted by the MHPRU LERs presented in this paper demonstrates the viability, value, and potential of this way of working., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Machin, Shah, Nicholls, Jeynes, TK, Trevillion and Vera San Juan.)
Published: 2023
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43. Experiences of Every Mind Matters, Public Health England's adult mental health literacy campaign: a qualitative interview study.

Author: Stuart R, Shah P, Olive RR, Trevillion K, and Henderson C
Subjects: Adult, Humans, Public Health, England, Health Promotion, Mental Health, Health Literacy
Abstract: Background: Every Mind Matters (EMM) is a publicly funded health campaign, launched in England in 2019, to equip adults to look after their mental health, and that of others, by offering online information about common problems: anxiety, low mood, sleep, and stress. This study is one component of an independent evaluation of EMM conducted by the NIHR Mental Health Policy Research Unit. Its aim is to explore individuals' experiences of the EMM campaign and website., Methods: Four researchers, including three with lived experience of using mental health services, conducted 20, one-off, semi-structured, online interviews with a range of adult participants, including a sample of EMM users and a purposively recruited sub-sample known to have severe or long-term mental health conditions. A codebook thematic analysis was undertaken, and four main themes were identified., Findings: There was an expectation from the name Every Mind Matters that its advice would address everyone. Almost all participants had experience of mental distress and looked to EMM for help with a current problem for themselves. All participants were complimentary about the EMM website and found it to be user-friendly (theme 1) and personalised (theme 2) especially the interactive feature Your Mind Plan quiz which responds with suggested actions to improve wellbeing and follows up with reminder emails. A few participants found the website information and/or Mind Plan suggestions to be life changing. Some participants wanted EMM to better acknowledge the contexts in which they live (theme 3) such as the limitations of health conditions and health services, and difficulties of crowded housing, social policy, and climate change. Many participants would like EMM to do more (theme 4), offer more interactivity, more choice, more information about available treatments, and more stratified advice to cover more severe mental health conditions., Conclusion: EMM is available to all, including people with common or severe mental disorders. In the context of overwhelmed mental health services, people with severe mental illness expect more from EMM than advice about common problems. EMM could build on its success by extending its remit to address a wider range of needs so that everyone is included., (© 2023. The Author(s).)
Published: 2023
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44. Caregiving and mental health needs in the significant others of women receiving inpatient and home treatment for acute severe postpartum mental illness.

Author: Atmore KH, Taylor BL, Potts LC, Trevillion K, and Howard LM
Subjects: Adult, Aged, Female, Humans, Male, Middle Aged, Pregnancy, Young Adult, Cohort Studies, Cross-Sectional Studies, Inpatients, Postpartum Period, Mental Disorders psychology, Mental Health, Sexual Partners, Spouses, Depression, Postpartum
Abstract: To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24-69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family., (© 2022. The Author(s).)
Published: 2023
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45. Observational prospective study of social media, smartphone use and self-harm in a clinical sample of young people: study protocol.

Author: Bye A, Carter B, Leightley D, Trevillion K, Liakata M, Branthonne-Foster S, Williamson G, Zenasni Z, and Dutta R
Subjects: Humans, Adolescent, Young Adult, Adult, Smartphone, Prospective Studies, Cross-Sectional Studies, Observational Studies as Topic, Social Media, Self-Injurious Behavior epidemiology, Self-Injurious Behavior psychology
Abstract: Introduction: Young people are the most frequent users of social media and smartphones and there has been an increasing speculation about the potential negative impacts of their use on mental health. This has coincided with a sharp increase in the levels of self-harm in young people. To date, studies researching this potential association are predominantly cross-sectional and reliant on self-report data, which precludes the ability to objectively analyse behaviour over time. This study is one of the first attempts to explore temporal patterns of real-world usage prior to self-harm, to identify whether there are usage patterns associated with an increased risk., Methods and Analysis: To study the mechanisms by which social media and smartphone use underpin self-harm in a clinical sample of young people, the Social media, Smartphone use and Self-harm in Young People (3S-YP) study uses a prospective, observational study design. Up to 600 young people aged 13-25 years old from secondary mental health services will be recruited and followed for up to 6 months. Primary analysis will compare real-world data in the 7 days leading up to a participant or clinician recorded self-harm episode, to categorise patterns of problematic usage. Secondary analyses will explore potential mediating effects of anxiety, depression, sleep disturbance, loneliness and bullying., Ethics and Dissemination: This study was approved by the National Research Ethics Service, London - Riverside, as well as by the Joint Research and Development Office of the Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Foundation Trust (SLaM), and the SLaM Clinical Research Interactive Search (CRIS) Oversight Committee. The findings from this study will be disseminated through peer-reviewed scientific journals, conferences, websites, social media and stakeholder engagement activities., Trial Registration Number: NCT04601220., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Published: 2023
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46. Maximizing the positive and minimizing the negative: Social media data to study youth mental health with informed consent.

Author: Leightley D, Bye A, Carter B, Trevillion K, Branthonne-Foster S, Liakata M, Wood A, Ougrin D, Orben A, Ford T, and Dutta R
Abstract: Social media usage impacts upon the mental health and wellbeing of young people, yet there is not enough evidence to determine who is affected, how and to what extent. While it has widened and strengthened communication networks for many, the dangers posed to at-risk youth are serious. Social media data offers unique insights into the minute details of a user's online life. Timely consented access to data could offer many opportunities to transform understanding of its effects on mental wellbeing in different contexts. However, limited data access by researchers is preventing such advances from being made. Our multidisciplinary authorship includes a lived experience adviser, academic and practicing psychiatrists, and academic psychology, as well as computational, statistical, and qualitative researchers. In this Perspective article, we propose a framework to support secure and confidential access to social media platform data for research to make progress toward better public mental health., Competing Interests: AW was Chair of the Board of the American Association of Suicidology. DO was a Board member for the Association for Child and Adolescent Mental Health. TF consults to place2Be a third sector organization that provides mental health to schools and is the Vice Chair of the Association for Child and Adolescent Mental Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Leightley, Bye, Carter, Trevillion, Branthonne-Foster, Liakata, Wood, Ougrin, Orben, Ford and Dutta.)
Published: 2023
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47. Mental health service use among pregnant and early postpartum women.

Author: Lee-Carbon L, Nath S, Trevillion K, Byford S, Howard LM, Challacombe FL, and Heslin M
Subjects: Female, Pregnancy, Humans, Prospective Studies, Postpartum Period, Anxiety, Pregnant People psychology, Mental Health Services, Mental Disorders diagnosis, Mental Disorders epidemiology, Mental Disorders therapy, Depression, Postpartum diagnosis, Depression, Postpartum epidemiology, Depression, Postpartum therapy
Abstract: Purpose: To explore the proportion and characteristics of women with a mental disorder who have contact with mental health services during pregnancy and the postnatal period in a maternity service in London., Methods: Data from the WEll-being in pregNancy stuDY (WENDY), a prospective cohort study, were used. Women were recruited at their first appointment for antenatal care and assessed for mental disorders using the Structured Clinical Interview DSM-IV Axis I/II Disorders for Research. Clinical, sociodemographic and psychosocial characteristics were collected. Mental health service use data were collected for the period from study entry to 3 months postpartum., Results: Two hundred women met diagnostic criteria for a mental disorder. Fifty-five (34%) of these had at least one contact with mental health services. Moderate depression (OR 7.44, CI 2.03-27.28, p < 0.01), severe depression (OR 10.5, CI 2.68-41.12, p < 0.01), past psychiatric hospital admission (OR 3.76, CI 1.05-13.44, p < 0.05), symptoms of anxiety (OR 3.95, CI 1.86-8.37, p < 0.001) and perceived low levels of social support (OR 0.43, CI 0.18-1.01, p = 0.05) were associated with an increased likelihood of contact with mental health services in univariate analyses. However, only moderate (OR 5.92, CI 1.31-26.78, p = 0.02) and severe depression (OR 6.04, CI 1.08-33.72, p = 0.04) remained significant in the multivariate regressions analyses., Conclusion: Only a third of women with a diagnosable mental disorder at their first antenatal appointment had any contact with mental health services during pregnancy or up to 3 months postpartum. Further research is warranted to elicit perinatal women's views about the potential barriers to accessing professional mental health care., (© 2022. The Author(s).)
Published: 2022
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48. Factors associated with re-admission in the year after acute postpartum psychiatric treatment.

Author: Taylor BL, Sweeney A, Potts LC, Trevillion K, and Howard LM
Subjects: Female, Hospitalization, Humans, Infant, Mental Health, Mothers psychology, Pregnancy, Mental Health Services, Postpartum Period psychology
Abstract: Purpose: To examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment., Methods: Secondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women's re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge., Results: Sixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35-214), and women who were re-admitted accessed a median of two further acute services (IQR 1-3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother-infant bond (aOR 1.03; 95% CI 1.01-1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90-1.00, p = 0.066) were associated with re-admission., Conclusion: This study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent-infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent-infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission., (© 2022. The Author(s).)
Published: 2022
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49. Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study.

Author: Howard LM, Trevillion K, Potts L, Heslin M, Pickles A, Byford S, Carson LE, Dolman C, Jennings S, Johnson S, Jones I, McDonald R, Pawlby S, Powell C, Seneviratne G, Shallcross R, Stanley N, Wieck A, and Abel KM
Subjects: Cohort Studies, Cost-Benefit Analysis, Female, Humans, Infant, Patient Discharge, Pregnancy, Aftercare, Mothers psychology
Abstract: Background: Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown., Aims: We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs))., Method: Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome., Results: Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group ( n = 105) had similar readmission rates to the non-MBU group ( n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes., Conclusions: We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Published: 2022
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50. Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review.

Author: Schlief M, Saunders KRK, Appleton R, Barnett P, Vera San Juan N, Foye U, Olive RR, Machin K, Shah P, Chipp B, Lyons N, Tamworth C, Persaud K, Badhan M, Black CA, Sin J, Riches S, Graham T, Greening J, Pirani F, Griffiths R, Jeynes T, McCabe R, Lloyd-Evans B, Simpson A, Needle JJ, Trevillion K, and Johnson S
Abstract: Background: Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed., Objective: This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms., Methods: Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including "gray literature," to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups., Results: A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed., Conclusions: Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings., Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910., (©Merle Schlief, Katherine R K Saunders, Rebecca Appleton, Phoebe Barnett, Norha Vera San Juan, Una Foye, Rachel Rowan Olive, Karen Machin, Prisha Shah, Beverley Chipp, Natasha Lyons, Camilla Tamworth, Karen Persaud, Monika Badhan, Carrie-Ann Black, Jacqueline Sin, Simon Riches, Tom Graham, Jeremy Greening, Farida Pirani, Raza Griffiths, Tamar Jeynes, Rose McCabe, Brynmor Lloyd-Evans, Alan Simpson, Justin J Needle, Kylee Trevillion, Sonia Johnson. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 29.09.2022.)
Published: 2022
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