Social connectedness for socially withdrawn and vulnerable young people's well-being: A qualitative study

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems for vulnerable young people

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. Following the 'social cure' theory, this study aimed to investigate the association, and potential mechanisms, of group membership continuity and reducing mental ill-health amongst vulnerable young people. Method(s): Cross-sectional survey data from a sample of 105 young people aged 16-35, collected approximately 1 year after the global COVID-19 outbreak (January-July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences), and the mediation of these associations by hope and social connectedness (in-person and online). Results and Conclusion(s): Prior multiple group memberships were associated with the preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as a means to potentially help prevent exacerbated symptoms and promote recovery of mental health problems, particularly during significant life events.

Hope and social connectedness as intervention targets in youth mental health

The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic Quantitative findings (N = 105) will be shared to demonstrated how belonging to multiple social groups can promote better mental health through the provision of hopefulness and social connectedness. Qualitative findings (N = 16) will be shared to elucidate how young people with complex emerging mental health problems experienced social connectedness during the ongoing social restrictions, and how they perceive social connection to be associated with their well-being Results also indicate young people's social preferences and the complex role of in-person versus online connection and interaction. A brief summary will be given regarding a linked trial (TOGETHER), evaluating the feasibility of delivering a social connectedness-focused intervention for young people with emerging complex mental health problems across clinical and community services in the UK.

Young people with complex emerging mental health problems: Packages of care and peri-pandemic experiences

The PRODIGY trial found that for young people with complex emerging mental health problems in the UK (N = 270), Social Recovery Therapy did not confer additional benefits above and beyond treatment as usual. Treatment as usual in the trial was, however, surprisingly comprehensive. A study was conducted to evaluate the provision of 'packages' of standard youth mental health care, and the association of provision with trial outcomes. In a subsequent study individuals who participated in the PRODIGY trial (N = 13) were interviewed about their experiences during the COVID-19 pandemic. The restrictions imposed by the COVID-19 pandemic have had significant and wide-ranging impacts on young people due to social isolation, disruption to education and employment opportunities, and young people with pre-existing mental health difficulties were considered to have been disproportionality affected. The results of this study indicated a reciprocal relationship between participants' mental health and their response to the pandemic. Participants told stories of both how the pandemic exacerbated their difficulties, but equally told stories of how their long-standing experiences of managing adversity supported them to cope during pandemic-related social restrictions.

Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

Diabetic foot care before and during the COVID-19 epidemic: Can we deliver?

Background: The COVID-19 pandemic produced extreme challenges for the delivery of safe and effective diabetes foot services at every level. This retrospective study (April 2020 to March 202) at Ipswich Hospital shows that, despite the challenges, adoption of innovative measures including change of referral pathways and templates, clinical triaging and liaisons with primary care services can still be effective in the delivery of safe and effective diabetic foot care. Results and outcomes: The total number of patients reviewed in secondary care during COVID-19 was 505 compared with 622 in the previous year (209-2020);the number of individual appointments attended was 2,754 (2,950). Similarly, hospital inpatient referrals were 380 with 736 reviews compared with 506 with ,028 reviews in the preceding year. During COVID-19, average HbA1c for diabetes foot patients was 8 . 2 ± . 7 5% (7.67±2.2%), uACR was 24.3±68.83 (24.32±72.38) and total cholesterol 4.9±.63 (3.97±.95). The total number of angioplasty procedures performed during COVID-19 was 44 (45), lower limb bypasses 5 (4) and lower limb endarterectomies 8 (6). During COVID-19 major amputations were 9 (5) and minor amputations 35 (43). Mortality in diabetic foot subjects was 52 (47) equating to 0 . 3% (7.5%) of the outpatient caseload. Conclusion: Compared with the pre-COVID-19 data, the outcomes obtained during COVID-19 demonstrate the importance of access to diabetic foot services in mitigating the risk of complications during a pandemic. Our data suggest appropriate early planning, close liaisons with care providers and timely interventions were key in reducing morbidity and mortality due to diabetic foot complications.