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Background Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. Aims To determine whether interventions provided to people caring... more
Background Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. Aims To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. Method We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). Results Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference -1.03, 95% CI -1.69 to -0.36) and support groups (SMD = -1.16, 95% CI -1.96 to -0.36). Psychoeducation had a benefit on psychological distress more than 6 months late...
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This study examined the impact of caring on women who were primary care-givers to those with schizophrenia. From the 46 women and 21 men carers assessed for the study, women were considered primary care-givers more often than men (83% v.... more
This study examined the impact of caring on women who were primary care-givers to those with schizophrenia. From the 46 women and 21 men carers assessed for the study, women were considered primary care-givers more often than men (83% v. 57%). Higher levels of burden among women primary carers were associated with living with patients, and more hours in contact
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Research Interests: Psychology, Cognitive Science, Psychiatry, Schizophrenia, Metabolism, and 30 moreAnterior Cingulate, Creatine, Magnetic Resonance Spectroscopy, Adolescent, Executive Function, Humans, Child, Child Abuse, Female, Cognitive Behaviour Therapy, Cognitive Therapy, Male, Regression Analysis, Young Adult, Follow-up studies, American, D-Aspartic Acid, Clinical Sciences, Children and Adolescents, Adult, Analysis of Variance, Short Term Memory, Choline, Cross Sectional Studies, Chemical Shift Imaging, Neurosciences, Frontal Lobe, Clinical Psychopharmacology, Cognition disorders, and Anterior cingulate cortex(Anterior Cingulate, Creatine, Magnetic Resonance Spectroscopy, Adolescent, Executive Function, Humans, Child, Child Abuse, Female, Cognitive Behaviour Therapy, Cognitive Therapy, Male, Regression Analysis, Young Adult, Follow-up studies, American, D-Aspartic Acid, Clinical Sciences, Children and Adolescents, Adult, Analysis of Variance, Short Term Memory, Choline, Cross Sectional Studies, Chemical Shift Imaging, Neurosciences, Frontal Lobe, Clinical Psychopharmacology, Cognition disorders, and Anterior cingulate cortex)
(Anterior Cingulate, Creatine, Magnetic Resonance Spectroscopy, Adolescent, Executive Function, Humans, Child, Child Abuse, Female, Cognitive Behaviour Therapy, Cognitive Therapy, Male, Regression Analysis, Young Adult, Follow-up studies, American, D-Aspartic Acid, Clinical Sciences, Children and Adolescents, Adult, Analysis of Variance, Short Term Memory, Choline, Cross Sectional Studies, Chemical Shift Imaging, Neurosciences, Frontal Lobe, Clinical Psychopharmacology, Cognition disorders, and Anterior cingulate cortex)
Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases... more
Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. On an intention-to-treat analysis, there were significant improvements in state paranoia an...
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In occupational settings, burnout is a common response to chronic exposure stressors and has been frequently documented in formal caregivers (i.e. paid psychiatric staff). However, the literature is limited on reports of burnout among... more
In occupational settings, burnout is a common response to chronic exposure stressors and has been frequently documented in formal caregivers (i.e. paid psychiatric staff). However, the literature is limited on reports of burnout among informal caregivers and particularly within early psychosis groups. The current study sought to investigate reports of burnout in carers of young adults treated within a specialist early psychosis service and links with key appraisals reported about the illness and coping. Seventy-two carers completed the Maslach Burnout Inventory along with self-report measures of coping styles and illness beliefs. Seventy-eight per cent of carers reported high burnout in at least one of the three key burnout markers (i.e. emotional exhaustion, depersonalization or low personal accomplishment). Seven per cent of carers met full criteria for high burnout across all the three domains. A carer's belief about the negative consequences of the illness for themselves was...
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Research Interests: Psychology, Intelligence, Community-Based Mental Health Services, Quality of life, Health Policy, and 15 moreAdolescent, England, Psychological Medicine, Humans, Female, Male, Feedback, Patient Satisfaction, Mental Disorders, Middle Aged, Questionnaires, Adult, Patient Care Team, Public health systems and services research, and Neurosciences
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Caregivers make a significant and growing contribution to the social and medical care of people with long-standing disorders. The effective provision of this care is dependent on their own continuing health. To investigate the... more
Caregivers make a significant and growing contribution to the social and medical care of people with long-standing disorders. The effective provision of this care is dependent on their own continuing health. To investigate the relationship between weekly time spent caregiving and psychiatric and physical morbidity in a representative sample of the population of England. Primary outcome measures were obtained from the Adult Psychiatric Morbidity Survey 2007. Self-report measures of mental and physical health were used, along with total symptom scores for common mental disorder derived from the Clinical Interview Schedule-Revised. In total, 25% (n = 1883) of the sample identified themselves as caregivers. They had poorer mental health and higher psychiatric symptom scores than non-caregivers. There was an observable decline in mental health above 10 h per week. A twofold increase in psychiatric symptom scores in the clinical range was recorded in those providing care for more than 20 ...
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BackgroundResponsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is... more
BackgroundResponsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is positively associated with pre-therapy grey matter volume in brain regions involved in cognitive processing.
Research Interests: Schizophrenia, Magnetic Resonance Imaging, Treatment, Morphometry, Cognitive Flexibility, and 17 moreMemory, Brain Mapping, Brain, Humans, Female, Cognitive Behaviour Therapy, Cognitive Therapy, Voxel Based Morphometry, Male, Cognitive Process, Middle Aged, Adult, Analysis of Variance, Psychotic Disorders, Nuclear Magnetic Resonance Imaging, Functional Laterality, and Magnetic resonance image
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Continuity of care is a central objective of community psychiatric services, but there is no consensus about its measurement. We developed measures of continuity of care suitable for routine use, and measured continuity and individual... more
Continuity of care is a central objective of community psychiatric services, but there is no consensus about its measurement. We developed measures of continuity of care suitable for routine use, and measured continuity and individual patient outcome over a period in which community services were developing. One hundred patients with severe mental illness receiving continuing care from two sectorised services were sampled and interviewed. Data were collected concerning their care over 20 months prior to interview. After 20 months prospective follow-up, they were re-interviewed. Continuity was defined as: perceived accessibility of services and knowledge about them, the number of keyworkers in a defined period of time, and the proportion of time out of contact with services. Continuity of care improved significantly on all measures over the period of the study. Individual patient outcome also improved, but in multiple regression models including clinical and demographic variables, measures of continuity were not significant predictors of outcome. Continuity was similar for white and non-white patients. Simple measures of continuity are useful in evaluating changes in the process of care, but they are not straightforwardly related to individual outcome.
Research Interests: Psychology, Cognitive Science, Community-Based Mental Health Services, Treatment Outcome, Prospective studies, and 14 moreHumans, Female, Male, Continuity of Care, Cohort Study, Mental Disorders, Ethnic Groups, Clinical Sciences, Great Britain, Severe Mental Illness, Adult, Patient Care Team, Continuity of Patient Care, and Communication Service
Despite an acknowledgement of the impact of serious mental disorders on informal caregivers, we still know little about how to best help them. The aim of the study was to evaluate the effectiveness of a two-phased carers'... more
Despite an acknowledgement of the impact of serious mental disorders on informal caregivers, we still know little about how to best help them. The aim of the study was to evaluate the effectiveness of a two-phased carers' intervention comprising family sessions followed by relatives' groups. This intervention was designed to be of 'intermediate' intensity, that is,one lying between brief educational programmes and long-term family psychoeducational treatments. An exploratory randomised controlled trial was conducted comparing the experimental support programme with 'standard' care. All carers of patients with a psychotic disorder from a defined population were approached. Outcome measures were based on a 'stress-appraisal-coping' model of caregiving. Despite concerted attempts to engage carers, only 42% participated in the study. The carers' programme did not offer any significant advantage on any of the outcome measures: psychological morbidity, negative appraisal, coping or social support. The severity of caregiving difficulties decreased over the study period for the group as a whole. There is still uncertainty about the most effective interventions for carers. Meeting 'needs' may not improve caregiver distress.
Research Interests: Psychology, Family Therapy, Cognitive Science, Social Support, Humans, and 15 moreFemale, Male, Social Psychiatry, Psychotic Disorder, Randomised Controlled Trial, Caregivers, Mental Disorder, Clinical Sciences, Middle Aged, Questionnaires, Randomized Controlled Trial, Psychotic Disorders, Family Intervention, Psychiatric, and Cost of Illness
High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate... more
High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying. A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software. Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.
Research Interests: Psychology, Cognitive Science, Mental Health, Qualitative methodology, Job Satisfaction, and 13 moreSocial Support, London, Self Help Groups, Humans, Time Management, Social Psychiatry, Qualitative Study, Mental health services, Clinical Sciences, Patient Care Team, Support Group, Boolean Satisfiability, and Health Personnel
This study examines whether the adoption of a more community based model in an inner city psychiatry service is accompanied by increasing "burnout", deteriorating mental health and decreasing job satisfaction amongst... more
This study examines whether the adoption of a more community based model in an inner city psychiatry service is accompanied by increasing "burnout", deteriorating mental health and decreasing job satisfaction amongst staff. Questionnaires were sent annually for 3 consecutive years to all mental health staff working in three adult mental health sectors in inner London. Main outcome measures were the 12-item General Health Questionnaire, Maslach Burn-out Inventory and a general job satisfaction measure. There was no significant change over time in the outcome measures, once confounding by job and demographic variables was examined. Being based in the community was associated with higher GHQ-12 scores (P = 0.02) when compared to in-patient staff over the 3 years. These results suggested that working in the community may be more stressful than working in in-patient services. However, there was no evidence to suggest that levels of stress are increasing over time, either in community-based or hospital-based staff.
Research Interests: Psychology, Cognitive Science, Mental Health, Community-Based Mental Health Services, Job Satisfaction, and 11 moreLondon, Humans, Regression Analysis, Social Psychiatry, Clinical Sciences, General Health, General Health Questionnaire, Adult, Longitudinal Study, Maslach Burnout Inventory, and Health Personnel
High levels of burnout and poor psychological well-being, but also relatively high levels of job satisfaction, have been found among mental health staff, especially those based in community settings. In order to investigate the basis of... more
High levels of burnout and poor psychological well-being, but also relatively high levels of job satisfaction, have been found among mental health staff, especially those based in community settings. In order to investigate the basis of these findings, a qualitative interview study was carried out, exploring mental health staff's views of their work and of its effects on them. A semi-structured interview was administered to a purposive sample of 30 professionals, including junior and senior members of each profession in both hospital and community settings. Interviews were transcribed verbatim and analysed using QSR NUD.IST software. For most professionals, contact with colleagues was one of the major rewards of the job. There was surprisingly little evidence of conflict or difficulties defining roles between disciplines, except for the social workers, for whom difficulty in defining roles in relation to other professions was a major preoccupation. Reported stresses differed between community and hospital staff. Community staff tended to find their contacts with patients highly rewarding, but also to feel burdened by a strong and uncomfortable sense of being constantly responsible for their clients' well-being and actions. Ward staff, on the other hand, identified as central difficulties in their job lack of autonomy, responsibility and scope for developing an independent therapeutic role. They felt demoralised by revolving door' patients and by violence and the need to restrain patients.
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Research Interests: Demography, Schizophrenia, Time Use, Social behavior, Humans, and 17 moreFemale, Cognitive Therapy, Male, Scale, Activity, Questionnaires, Social Functioning, Validation Studies, Adult, Time Factors, Psychotic Disorders, Social Behavior, Small samples, Dimensions, Psychomotor Disorders, Time Budget, and Cognition disorders
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This study investigated the relationship between patient-rated unmet needs and subjective quality of life using routine outcome data. 265 mental health service patients from South Verona were assessed using the Camberwell Assessment of... more
This study investigated the relationship between patient-rated unmet needs and subjective quality of life using routine outcome data. 265 mental health service patients from South Verona were assessed using the Camberwell Assessment of Need, the Lancashire Quality of Life Profile, and other standardised assessments of symptoms, disability, function and service satisfaction. At 1-year follow-up, 166 patients were still in contact, of whom 121 patients (73%) were re-assessed. Higher baseline quality of life was associated with being male, a diagnosis of psychosis, higher disability, higher satisfaction with care, fewer staff-rated or patient-rated unmet needs, and fewer patient-rated met needs (accounting for 40% of the variance). Specifically, fewer baseline patient-rated unmet needs were cross-sectionally associated with a higher quality of life (B = -0.08, 95% CI -0.12 to -0.04). Apart from its baseline value, the only baseline predictor of follow-up QoL was patient-rated unmet need (B = -0.08, 95% CI -0.21 to -0.09), accounting for 58% of the variance in follow-up quality of life. Graphical chain modelling confirmed this association. The association between high numbers of unmet needs and low subjective quality of life appears increasingly robust across several studies. Future research will need to investigate whether changes in needs precede changes in quality of life. This study provides further evidence that a policy of actively assessing and addressing patient-rated unmet needs may lead to improved quality of life.