Women's experiences of the diagnostic journey in uterine adenomyosis: a scoping review protocol.

INTRODUCTION: Uterine adenomyosis is a benign gynaecological disease that causes physical and psychological problems, impacting on relationships. It is poorly understood and consequently may be diagnosed late. This protocol describes the process of conducting a systematic scoping review to retrieve and describe literature examining the daily experience and impact of living with uterine adenomyosis. It will explore the journey to diagnosis (and perceptions of what this process is like); identify the main concepts currently used in the literature and highlight gaps in knowledge for future research in relevant populations. METHODS AND ANALYSIS: Using the Joanna Briggs Institute methodology, the population-concept-context approach is used to form clear review questions. A three-phase search strategy will locate published and unpublished evidence from multiple sources. All articles reporting on the personal experiences of women diagnosed with uterine adenomyosis will be considered. Findings from qualitative, quantitative and mixed-method study designs from all settings will be included, not limited by geography but restricted to English. Documents will be screened by the primary researcher, supported by university supervisors. Search outputs will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram. No formal quality appraisal will be conducted. Review findings will be descriptively collated and reported consistent with the Scoping Review Extension of the PRISMA checklist. Patient and public involvement engagement reflected a positive response for the project that this protocol supports. ETHICS AND DISSEMINATION: As primary data will not be collected, formal ethical approval is not required. Prepared as part of a professional doctorate thesis, the findings of this study will be disseminated via peer-reviewed publications, conference presentations, support groups and social media networks.

On Dimensionality, Measurement Invariance, and Suitability of Sum Scores for the PHQ-9 and the GAD-7.

In psychiatry, severity of mental health conditions and their change over time are usually measured via sum scores of items on psychometric scales. However, inferences from such scores can be biased if psychometric properties such as unidimensionality and temporal measurement invariance for instruments are not met. Here, we aimed to evaluate these properties for common measures of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder Assessment-7) in a large clinical sample (N = 22,362) undergoing psychotherapy. In addition, we tested consistency in dimensionality results across different methods (parallel analysis, factor analysis, explained common variance, the partial credit model, and the Mokken model). Results showed that while both Patient Health Questionnaire-9 and Generalized Anxiety Disorder Assessment-7 are multidimensional instruments with highly correlated factors, there is justification for sum scores as measures of severity. Temporal measurement invariance across 10 therapy sessions was evaluated. Strict temporal measurement invariance was established in both scales, allowing researchers to compare sum scores as severity measures across time.

Monoamine Oxidase A (MAOA) Gene and Personality Traits from Late Adolescence through Early Adulthood: A Latent Variable Investigation.

Very few molecular genetic studies of personality traits have used longitudinal phenotypic data, therefore molecular basis for developmental change and stability of personality remains to be explored. We examined the role of the monoamine oxidase A gene (MAOA) on extraversion and neuroticism from adolescence to adulthood, using modern latent variable methods. A sample of 1,160 male and 1,180 female participants with complete genotyping data was drawn from a British national birth cohort, the MRC National Survey of Health and Development (NSHD). The predictor variable was based on a latent variable representing genetic variations of the MAOA gene measured by three SNPs (rs3788862, rs5906957, and rs979606). Latent phenotype variables were constructed using psychometric methods to represent cross-sectional and longitudinal phenotypes of extraversion and neuroticism measured at ages 16 and 26. In males, the MAOA genetic latent variable (AAG) was associated with lower extraversion score at age 16 (ß = -0.167; CI: -0.289, -0.045; p = 0.007, FDRp = 0.042), as well as greater increase in extraversion score from 16 to 26 years (ß = 0.197; CI: 0.067, 0.328; p = 0.003, FDRp = 0.036). No genetic association was found for neuroticism after adjustment for multiple testing. Although, we did not find statistically significant associations after multiple testing correction in females, this result needs to be interpreted with caution due to issues related to x-inactivation in females. The latent variable method is an effective way of modeling phenotype- and genetic-based variances and may therefore improve the methodology of molecular genetic studies of complex psychological traits.

Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives.

BACKGROUND: Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area. MATERIALS & METHODS: We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. RESULTS: The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. DISCUSSION: In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.

Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK.

BACKGROUND: Evidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services. METHODS: As part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis. FINDINGS: 14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient -1·68, 95% CI -3·22 to -0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73-31·50; p=0·0069). INTERPRETATION: Our findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services. FUNDING: Wellcome Trust, National Institute for Health Research.

An evaluation of computerized adaptive testing for general psychological distress: combining GHQ-12 and Affectometer-2 in an item bank for public mental health research.

BACKGROUND: Recent developments in psychometric modeling and technology allow pooling well-validated items from existing instruments into larger item banks and their deployment through methods of computerized adaptive testing (CAT). Use of item response theory-based bifactor methods and integrative data analysis overcomes barriers in cross-instrument comparison. This paper presents the joint calibration of an item bank for researchers keen to investigate population variations in general psychological distress (GPD). METHODS: Multidimensional item response theory was used on existing health survey data from the Scottish Health Education Population Survey (n = 766) to calibrate an item bank consisting of pooled items from the short common mental disorder screen (GHQ-12) and the Affectometer-2 (a measure of "general happiness"). Computer simulation was used to evaluate usefulness and efficacy of its adaptive administration. RESULTS: A bifactor model capturing variation across a continuum of population distress (while controlling for artefacts due to item wording) was supported. The numbers of items for different required reliabilities in adaptive administration demonstrated promising efficacy of the proposed item bank. CONCLUSIONS: Psychometric modeling of the common dimension captured by more than one instrument offers the potential of adaptive testing for GPD using individually sequenced combinations of existing survey items. The potential for linking other item sets with alternative candidate measures of positive mental health is discussed since an optimal item bank may require even more items than these.

Computerized adaptive testing of population psychological distress: simulation-based evaluation of GHQ-30.

PURPOSE: Goldberg's General Health Questionnaire (GHQ) items are frequently used to assess psychological distress but no study to date has investigated the GHQ-30's potential for adaptive administration. In computerized adaptive testing (CAT) items are matched optimally to the targeted distress level of respondents instead of relying on fixed-length versions of instruments. We therefore calibrate GHQ-30 items and report a simulation study exploring the potential of this instrument for adaptive administration in a longitudinal setting. METHODS: GHQ-30 responses of 3445 participants with 2 completed assessments (baseline, 7-year follow-up) in the UK Health and Lifestyle Survey were calibrated using item response theory. Our simulation study evaluated the efficiency of CAT administration of the items, cross-sectionally and longitudinally, with different estimators, item selection methods, and measurement precision criteria. RESULTS: To yield accurate distress measurements (marginal reliability at least 0.90) nearly all GHQ-30 items need to be administered to most survey respondents in general population samples. When lower accuracy is permissible (marginal reliability of 0.80), adaptive administration saves approximately 2/3 of the items. For longitudinal applications, change scores based on the complete set of GHQ-30 items correlate highly with change scores from adaptive administrations. CONCLUSIONS: The rationale for CAT-GHQ-30 is only supported when the required marginal reliability is lower than 0.9, which is most likely to be the case in cross-sectional and longitudinal studies assessing mean changes in populations. Precise measurement of psychological distress at the individual level can be achieved, but requires the deployment of all 30 items.

Calibrating well-being, quality of life and common mental disorder items: psychometric epidemiology in public mental health research.

BACKGROUND: The assessment of 'general health and well-being' in public mental health research stimulates debates around relative merits of questionnaire instruments and their items. Little evidence regarding alignment or differential advantages of instruments or items has appeared to date. AIMS: Population-based psychometric study of items employed in public mental health narratives. METHOD: Multidimensional item response theory was applied to General Health Questionnaire (GHQ-12), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and EQ-5D items (Health Survey for England, 2010-2012; n = 19 290). RESULTS: A bifactor model provided the best account of the data and showed that the GHQ-12 and WEMWBS items assess mainly the same construct. Only one item of the EQ-5D showed relevant overlap with this dimension (anxiety/depression). Findings were corroborated by comparisons with alternative models and cross-validation analyses. CONCLUSIONS: The consequences of this lack of differentiation (GHQ-12 v. WEMWBS) for mental health and well-being narratives deserves discussion to enrich debates on priorities in public mental health and its assessment.

Effects of ignoring clustered data structure in confirmatory factor analysis of ordered polytomous items: a simulation study based on PANSS.

Statistical theory indicates that hierarchical clustering by interviewers or raters needs to be considered to avoid incorrect inferences when performing any analyses including regression, factor analysis (FA) or item response theory (IRT) modelling of binary or ordinal data. We use simulated Positive and Negative Syndrome Scale (PANSS) data to show the consequences (in terms of bias, variance and mean square error) of using an analysis ignoring clustering on confirmatory factor analysis (CFA) estimates. Our investigation includes the performance of different estimators, such as maximum likelihood, weighted least squares and Markov Chain Monte Carlo (MCMC). Our simulation results suggest that ignoring clustering may lead to serious bias of the estimated factor loadings, item thresholds, and corresponding standard errors in CFAs for ordinal item response data typical of that commonly encountered in psychiatric research. In addition, fit indices tend to show a poor fit for the hypothesized structural model. MCMC estimation may be more robust against clustering than maximum likelihood and weighted least squares approaches but further investigation of these issues is warranted in future simulation studies of other datasets. Copyright © 2015 John Wiley & Sons, Ltd.

Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial.

BACKGROUND: General practitioners are usually the first health professionals to be contacted by people with early signs of psychosis. We aimed to assess whether increased liaison between primary and secondary care improves the clinical effectiveness and cost-effectiveness of detection of people with, or at high risk of developing, a first psychotic illness. METHODS: Our Liaison and Education in General Practices (LEGs) study was a cluster-randomised controlled trial of primary care practices (clusters) in Cambridgeshire and Peterborough, UK. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign, consisting of biannual guidelines to help identify and refer individuals with early signs of psychosis) or a high-intensity intervention, which additionally included a specialist mental health professional who liaised with every practice and a theory-based educational package. Practices were not masked to group allocation. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. The primary outcome was number of referrals of patients at high risk of developing psychosis to the early intervention service per practice site. New referrals were assessed clinically and stratified into those who met criteria for high risk or first-episode psychotic illness (FEP; together: psychosis true positives), and those who did not fulfil such criteria for psychosis (false positives). Referrals from PAU practices were also analysed. We assessed cost-effectiveness with decision analytic modelling in terms of the incremental cost per additional true positive identified. The trial is registered at the ISRCTN registry, number ISRCTN70185866. FINDINGS: Between Dec 22, 2009, and Sept 7, 2010, 54 of 104 eligible practices provided consent and between Feb 16, 2010, and Feb 11, 2011, these practices were randomly allocated to interventions (28 to low intensity and 26 to high intensity); the remaining 50 practices comprised the PAU group. Two high-intensity practices were excluded from the analysis. In the 2 year intervention period, high-intensity practices referred more FEP cases than did low-intensity practices (mean 1.25 [SD 1.2] for high intensity vs 0.7 [0.9] for low intensity; incidence rate ratio [IRR] 1.9, 95% CI 1.05-3.4, p=0.04), although the difference was not statistically significant for individuals at high risk of psychosis (0.9 [1.0] vs 0.5 [1.0]; 2.2, 0.9-5.1, p=0.08). For high risk and FEP combined, high-intensity practices referred both more true-positive (2.2 [1.7] vs 1.1 [1.7]; 2.0, 1.1-3.6, p=0.02) and false-positive (2.3 [2.4] vs 0.9 [1.2]; 2.6, 1.3-5.0, p=0.005) cases. Referral patterns did not differ between low-intensity and PAU practices. Total cost per true-positive referral in the 2 year follow-up was £26,785 in high-intensity practices, £27,840 in low-intensity practices, and £30,007 in PAU practices. INTERPRETATION: This intensive intervention to improve liaison between primary and secondary care for people with early signs of psychosis was clinically and cost effective. FUNDING: UK National Institute for Health Research.

Validity of single item responses to short message service texts to monitor depression: an mHealth sub-study of the UK ACUDep trial.

BACKGROUND: An increasing number of research designs are using text messaging (SMS) as a means of self-reported symptom and outcome monitoring in a variety of long-term health conditions, including severity ratings of depressed mood. The validity of such a single item SMS score to measure latent depression is not currently known and is vital if SMS data are to inform clinical evaluation in the future. METHODS: A sub-set of depressed participants in the UK ACUDep trial submitted a single SMS text score (R-SMS-DS) between 1 and 9 on how depressed they felt around the same time as completing the PHQ-9 depression questionnaire on paper at 3 months follow-up of the trial. Exploratory categorical data factor analysis (EFA) was used to ascertain the alignment of R-SMS-DS scores with the factor structure of the PHQ-9. Any response bias with regard to age or gender was assessed by differential item functioning (DIF) analysis. RESULTS: Depression scores based on the PHQ-9 and R-SMS-DS at 3 months were available for 337 participants (74 % female; mean age: 42 years, SD = 11.1), 213 of which completed the two outcomes within 6 days of each other. R-SMS-DS scores aligned with the underlying latent depression of the PHQ-9 (factor loading of 0.656) and in particular its affective rather than somatic dimension. The R-SMS-DS score was most strongly correlated with depressed mood (r = 0.607), feeling bad about oneself (r = 0.588) and anhedonia (r = 0.573). R-SMS-DS responses were invariant with respect to gender (p = 0.302). However, there was some evidence for age related response bias (p = 0.031), with older participants being more likely to endorse lower R-SMS-DS scores than younger ones. CONCLUSIONS: The R-SMS-DS used in the ACUDep trial was found to be a valid measure of latent affective depression with no gender related response bias. This text message item may therefore represent a useful assessment and monitoring tool meriting evaluation in further research. For future study designs we recommend the collection of outcome data by new health technologies in combination with gold standard instruments to ensure concurrent validity.

Factor analysis of treatment outcomes from a UK specialist addiction service: relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and 10-item Clinical Outcomes in Routine Evaluation.

INTRODUCTION AND AIMS: To examine the relationship between three outcome measures used by a specialist addiction service (UK): the Leeds Dependence Questionnaire (LDQ), the Social Satisfaction Questionnaire (SSQ) and the 10-item Clinical Outcomes in Routine Evaluation (CORE-10). DESIGN AND METHOD: A clinical sample of 715 service user records was extracted from a specialist addiction service (2011) database. The LDQ (dependence), SSQ (social satisfaction) and CORE-10 (psychological distress) were routinely administered at the start of treatment and again between 3 and 12 months post-treatment. A mixed pre/post-treatment dataset of 526 service users was subjected to exploratory factor analysis. Parallel Analysis and the Hull method were used to suggest the most parsimonious factor solution. RESULTS: Exploratory factor analysis with three factors accounted for 66.2% of the total variance but Parallel Analysis supported two factors as sufficient to account for observed correlations among items. In the two-factor solution, LDQ items and nine of the 10 CORE-10 items loaded on the first factor >0.41, and the SSQ items on factor 2 with loadings >0.63. A two dimensional summary appears sufficient and clinically meaningful. DISCUSSION AND CONCLUSIONS: Among specialist addiction service users, social satisfaction appears to be a unique construct of addiction and is not the same as variation due to psychological distress or dependence. Our interpretation of the findings is that dependence is best thought of as a specific psychological condition subsumed under the construct psychological distress.

The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: the WAYS study.

BACKGROUND: War experiences (WE) are frequently associated with mental health problems. Whether different types of WE vary in predicting which problem, or how severe, in former child soldiers (FCS) remains unknown. METHODS: Using data from the first wave of an on-going longitudinal cohort study (the WAYS study), we investigated relations between types of WE and symptoms of depression/anxiety among FCS in Northern Uganda (N = 539, baseline age = 22.39; SD = 2.03, range 18-25). Using robust Maximum Likelihood estimation in SEM, regression analyses were performed to relate binary indicators of types of WE to a single latent factor capturing symptoms of depression/anxiety. RESULTS: SEM results showed that "direct personal harm", "witnessing violence", "deaths", "threat to loved ones", "involvement in hostilities", and "sexual abuse" indicators were related to reported symptoms of depression/anxiety irrespective of gender and age. Multivariable models revealed independent associations of "witnessing violence" (ß = 0.29, SE = 0.09, p < 0.001) and "deaths" (ß = 0.14, SE = 0.05, p < 0.001) with symptoms of depression/anxiety in both sexes. "Sexual abuse" (ß = 0.32, SE = 0.16, p < 0.001) independently predicted symptoms of depression/anxiety for female but not male youths whilst "threat to loved ones" (ß = 0.13, SE = 0.07, p < 0.05) independently predicted symptoms of depression/anxiety in male but not female youths. CONCLUSIONS: Dimensions of WE predicted symptoms of depression/anxiety differently, but it is hard to establish their causal status. Our findings suggest that it might be fruitful to consider such exposure variations of WE when designing interventions to mitigate the symptoms of depression/anxiety on male and female FCS.

Multilevel ordinal factor analysis of the positive and negative syndrome scale (PANSS).

Clinical assessments of the presence and severity of psychopathology are often collected by health care professionals in mental health services or clinical researchers trained to use semi-structured interviews. Clustering by interviewer or rater needs to be considered when performing psychometric analyses such as factor analysis or item response modelling as non-independence of observations arises in these situations. We apply more suitable multilevel methods to analyse ordinally scored Positive and Negative Syndrome Scale (PANSS) items. Our aim is to highlight the differences in results that occur when the data are analysed using a hierarchically sensitive approach rather than using a traditional (aggregated) analysis. Our sample (n = 507) consisted of patients diagnosed with schizophrenia who participated in a multi-centre randomized control clinical trial, the DIALOG study. Analyses reported and compared include an exploratory factor analysis as well as several recently published multifactor models re-estimated within a confirmatory analysis framework. Our results show that the fit of the model and the parsimony of the exploratory factor analysis (EFA) models indicated by the number of factors necessary to explain the inter-correlation among PANSS items improved significantly when data clustering is taken into account through multilevel analysis. Our modeling results support the pentagonal PANSS model first proposed by White et al. (1997). Copyright © 2014 John Wiley & Sons, Ltd.

Postwar environment and long-term mental health problems in former child soldiers in Northern Uganda: the WAYS study.

BACKGROUND: War experiences (WE) and postwar environments (PWE) are associated with mental ill-health. The present study aims to investigate the pathways from WE and PWE to mental ill-health and to define opportunities for intervention through analysis of the war-affected youths study (WAYS) cohort study. METHOD: WAYS is an ongoing study of a large cohort of former child soldiers being conducted in Uganda. Mental health problems, subjective WE and PWE contexts were assessed by local adaptations of internationally developed measures for use with former child soldiers at least 6 years after the end of the war. Structural equation modeling was used to test two mediation hypotheses: (1) the 'trauma model' in which WE directly influence long-term mental health and (2) the 'psychosocial path' in which WE influence long-term mental health through PWE stressors. RESULTS: WE were linked to depression/anxiety (ß=0.15 (95% CI 0.01 to 0.30)) through PWE (accounting for 44% of the variance in the relationship between these variables) and to conduct problems (ß=0.23 (95% CI 0.03 to 0.43); (accounting for 89% of the variance, ie, near complete mediation)). The direct relation between WE and depression/anxiety attenuated but remained statistically significant. For conduct problems, the direct relationship was no longer significant after accounting for PWE. CONCLUSIONS: PWE are a key determinant of continued mental health problems in former child soldiers. Interventions to reduce long-term mental problems should address both PWE stressors (psychosocial model) and specialised mental healthcare (trauma model) and consider both models of intervention as complementary.

Adolescent self-organization predicts midlife memory in a prospective birth cohort study.

Childhood and adolescent mental health have a lasting impact on adult life chances, with strong implications for subsequent health, including cognitive aging. Using the British 1946 birth cohort, the authors tested associations between adolescent conduct problems, emotional problems and aspects of self-organization, and verbal memory at 43 years and rate of decline in verbal memory from 43 to 60-64 years. After controlling for childhood intelligence, adolescent self-organization was positively associated with verbal memory at 43 years, mainly through educational attainment, although not with rate of memory decline. Associations between adolescent conduct and emotional problems and future memory were of negligible magnitude. It has been suggested that interventions to improve self-organization may save a wide range of societal costs; this study also suggests that this might also benefit cognitive function in later life.

Rumination, anxiety, depressive symptoms and subsequent depression in adolescents at risk for psychopathology: a longitudinal cohort study.

BACKGROUND: A ruminative style of responding to low mood is associated with subsequent high depressive symptoms and depressive disorder in children, adolescents and adults. Scores on self-report rumination scales correlate strongly with scores on anxiety and depression symptom scales. This may confound any associations between rumination and subsequent depression. METHODS: Our sample comprised 658 healthy adolescents at elevated risk for psychopathology. This study applied ordinal item (non-linear) factor analysis to pooled items from three self-report questionnaires to explore whether there were separate, but correlated, constructs of rumination, depression and anxiety. It then tested whether rumination independently predicted depressive disorder and depressive symptoms over the subsequent 12 months, after adjusting for confounding variables. RESULTS: We identified a single rumination factor, which was correlated with factors representing cognitive symptoms of depression, somatic symptoms of depression and anxiety symptoms; and one factor representing adaptive responses to low mood. Elevated rumination scores predicted onset of depressive disorders over the subsequent year (p = 0.035), and levels of depressive symptoms 12 months later (p < 0.0005), after adjustment for prior levels of depressive and anxiety symptoms. CONCLUSION: High rumination predicts onset of depressive disorder in healthy adolescents. Therapy that reduces rumination and increases distraction/problem-solving may reduce onset and relapse rates of depression.

Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study).

War experiences are associated with the risk of long-term mental health problems. The War-affected Youths (WAYS) Study comprises a cohort of 539 youths (61% female) aged between 18 to 25 (at baseline) randomly sampled from the population of war-affected youths in northern Uganda. The study aims to chart the trajectory of long-term mental health consequences of war and the roles of individual, family, and community contextual risk and protective factors in influencing the course of mental health using Social Ecology Model, thus, addressing both the individual and its social ecology. Knowledge of postwar contexts may inform policy and guide interventions on postwar psychosocial adjustment and reintegration in conflict-prone Great Lakes region of Africa (Rwanda, Burundi, DR Congo, Uganda, Central African Republic, and South Sudan). Two waves of data collection have been conducted and more data collection is planned. At baseline, information on demographic characteristics, pre-war experiences, psychosocial outcomes, coping, stigma/discrimination, family and community acceptance and relationship, family functioning, and post-war experiences were obtained. At follow-up, information on general health, gender-based violence, PTSD, social skills, trauma memory quality, rumination, self-esteem, and psychosocial outcomes were collected. Approval to access the data can be obtained on application to the Principal Investigator upon submission of a research proposal with ethical approval from the applicant's institution. This research is funded by Wellcome Trust and Gulu University.

Comparison of high and low intensity contact between secondary and primary care to detect people at ultra-high risk for psychosis: study protocol for a theory-based, cluster randomized controlled trial.

BACKGROUND: The early detection and referral to specialized services of young people at ultra-high risk (UHR) for psychosis may reduce the duration of untreated psychosis and, therefore, improve prognosis. General practitioners (GPs) are usually the healthcare professionals contacted first on the help-seeking pathway of these individuals. METHODS/DESIGN: This is a cluster randomized controlled trial (cRCT) of primary care practices in Cambridgeshire and Peterborough, UK. Practices are randomly allocated into two groups in order to establish which is the most effective and cost-effective way to identify people at UHR for psychosis. One group will receive postal information about the local early intervention in psychosis service, including how to identify young people who may be in the early stages of a psychotic illness. The second group will receive the same information plus an additional, ongoing theory-based educational intervention with dedicated liaison practitioners to train clinical staff at each site. The primary outcome of this trial is count data over a 2-year period: the yield - number of UHR for psychosis referrals to a specialist early intervention in psychosis service - per primary care practice. DISCUSSION: There is little guidance on the essential components of effective and cost-effective educational interventions in primary mental health care. Furthermore, no study has demonstrated an effect of a theory-based intervention to help GPs identify young people at UHR for psychosis. This study protocol is underpinned by a robust scientific rationale that intends to address these limitations. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70185866.