The experience of living alone as an older woman in the UK during the Covid pandemic: an interpretative phenomenological analysis.

BACKGROUND AND OBJECTIVES: More people are living alone across the life course: in later life this can have implications for practical and psychosocial support. The Covid pandemic emphasised the importance of this when the UK government restricted movement outside of households to limit the spread of disease. This had important ramifications regarding social contact and practical support. The objectives of this study were to explore the experience of older women living alone during this time, with a focus on health and wellbeing. RESEARCH DESIGN AND METHODS: This study used an Interpretative Phenomenological approach. Semi-structured interviews were undertaken with seven women (aged 65 +), living alone in the UK. Interviews were carried out between May and October 2020. Interpretative Phenomenological Analysis was used to analyse the transcripts. RESULTS: Findings show that life course events shaped how living alone was experienced in later life. Convergences and divergences in lived experience were identified. Three superordinate themes emerged from the Interpretative Phenomenological Analysis: Productivity, Ownership, and Interconnectedness. DISCUSSION AND IMPLICATIONS: Findings highlight the importance of life course events in shaping the experience of later life. They also provide a better understanding of the lived experience of living alone as an older woman, increasing knowledge of this group and how living alone can affect health and wellbeing. Implications for research and practice are discussed, such as the importance of recognising the specific support needs for this group in later life, and the need for further knowledge about groups whose needs are not met by standard practice.

Older Women Living Alone in the UK: Does Their Health and Wellbeing Differ from Those Who Cohabit?

With an increased prevalence of people living alone in later life, understanding the health and wellbeing of older women living alone in the UK is an important area of research. Little is known about health and wellbeing in this population and whether they differ from those who cohabit. This paper fills this research gap. Analysis was undertaken of Wave 8 of the Understanding Society Household Panel Survey, including variables such as internet use and volunteering. Differences were found between those who live alone and cohabit. Volunteering was a predictor of better health outcomes for those who lived alone but not for those who cohabit, despite similar rates of volunteering. Internet use predicted some better health outcome for those who cohabit but poorer for those who live alone. This suggests lifestyle factors vary in how they affect the health and wellbeing of older women, depending on cohabitation status.

The role of rumination in adjusting to termination of pregnancy for fetal abnormality: Rumination as a predictor and mediator of posttraumatic growth.

OBJECTIVE: Rumination is important in adjusting to traumatic events. Evidence suggests that deliberate rumination predicts posttraumatic growth (PTG), and mediates the relationship between coping and PTG. This study examined the relationship between rumination and psychological adjustment following pregnancy termination for fetal abnormality (TFA). METHOD: A cross-sectional, online study was conducted with women who had undergone TFA. Women were recruited from a support organization; 161 women completed the Brief COPE, the Perinatal Grief Scale, the Event-Related Rumination Inventory, and the Posttraumatic Growth Inventory. Data were analyzed using regression and mediation analyses. RESULTS: The results show that women engaged in high levels of intrusive and deliberate rumination post-TFA and that intrusive rumination predicted grief. Intrusive and deliberate rumination predicted PTG, although intrusive rumination was a negative predictor of growth. Deliberate rumination mediated the relationship between grief and PTG. It also mediated the path between positive reframing and PTG, and religious coping and PTG, although the mediation effect depended upon the inclusion of the grief variable in the models. CONCLUSIONS: The results confirm the applicability of the PTG model to TFA and support the relevance of rumination to the PTG experience. The results also have clinical implications. Given the positive relationship between deliberate rumination and PTG, promoting interventions that encourage reflective thinking and narrative construction would benefit women post-TFA, particularly those experiencing high levels of distress and/or at risk of complicated grief. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Improving socio-emotional health for pupils in early secondary education with Pyramid: A school-based, early intervention model.

BACKGROUND: Policymakers are focusing increased attention on the role of schools to promote and support children's mental health, and evidence-based models of good practice are in demand. Pyramid Club is a school-based, socio-emotional intervention, demonstrably effective with primary-aged pupils. AIMS: This study extends previous Pyramid Club evaluations by examining effectiveness with pupils in early secondary education; service users' perceptions and experiences were investigated to increase understanding of Pyramid's impact, thus supporting enhanced practice. SAMPLE: Participants (n = 126) comprised selected pupils, aged 11-14 (52 males; 74 females), who completed the 10 week programme (Pyramid group) and a non-intervention comparison group. Club leaders (n = 23) were trained, Pyramid volunteers. METHODS: A mixed-methods design was implemented. The Strengths and Difficulties Questionnaire (SDQ), informant-rated version (Goodman, 1997, J Child Psychol Psychiat, 38, 581) and self-report version (Goodman, Meltzer, & Bailey, 1998, Europ Child Adolesc Psychiatry, 7, 125), was used to measure socio-emotional well-being: pre-club (baseline assessment), post-test (within 2 weeks of programme completion), and at 12-month follow-up (informant-rated version only). Focus groups were conducted separately with Pyramid pupils and Club leaders. RESULTS: Findings from informants and self-reports identified significant improvements for the Pyramid group in total difficulties and on pertinent SDQ subscales (e.g., emotional symptoms and peer relationship problems) at post-test. Improvements were sustained at 12-month follow-up. Comparison pupils demonstrated minimal change over time. Thematic analysis of qualitative data supported the quantitative findings and provided valuable insights into the Pyramid Club experience. CONCLUSIONS: Findings contribute to evidence-based, preventative models for the early adolescent population and support the social validity of Pyramid Club.

Pregnancy termination for fetal abnormality: are health professionals' perceptions of women's coping congruent with women's accounts?

BACKGROUND: Pregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women's experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women's experience. This qualitative study examined health professionals' perceptions of women's coping with TFA and assessed to what extent these perceptions are congruent with women's accounts. METHODS: Fifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women's accounts of their own coping processes to identify similarities and differences. RESULTS: Health professionals' perceptions of women's coping processes were congruent with women's accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women's idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women's long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women. CONCLUSIONS: Health professionals' perceptions of women's coping with TFA closely matched women's accounts, suggesting a high level of understanding. However, the lack of insight into women's long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief.

BACKGROUND: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA's negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study's objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG. DESIGN: An online, retrospective survey was conducted with 161 women. METHODS: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses. RESULTS: Moderate levels of PTG were observed for "relating to others," "personal strengths" and "appreciation of life." "Positive reframing" was a significant predictor of PTG. Despite using mainly "adaptive" coping strategies, women's grief levels were high. CONCLUSIONS: "Adaptive" coping strategies such as, "positive reframing" are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women's experience, may be beneficial.

Gabapentinoid abuse in order to potentiate the effect of methadone: a survey among substance misusers.

BACKGROUND/AIMS: There is emerging evidence of gabapentin and pregabalin (gabapentinoid) abuse, particularly in the substance misuse population, and some suggestion of gabapentinoids being abused alongside methadone. METHODS: A questionnaire-based survey was carried out in six substance misuse clinics, looking for evidence of gabapentinoid abuse. RESULTS: 22% (29/129) of respondents admitted to abusing gabapentinoids, and of these, 38% (11/29) abused gabapentinoids in order to potentiate the 'high' they obtained from methadone. CONCLUSIONS: Gabapentinoid abuse along with methadone has not previously been described. These findings are of relevance to clinicians working within both substance misuse services and chronic pain services.

Termination of pregnancy for fetal abnormality: a meta-ethnography of women's experiences.

Due to technological advances in antenatal diagnosis of fetal abnormalities, more women face the prospect of terminating pregnancies on these grounds. Much existing research focuses on women's psychological adaptation to this event. However, there is a lack of holistic understanding of women's experiences. This article reports a systematic review of qualitative studies into women's experiences of pregnancy termination for fetal abnormality. Eight databases were searched up to April 2014 for peer-reviewed studies, written in English, that reported primary or secondary data, used identifiable and interpretative qualitative methods, and offered a valuable contribution to the synthesis. Altogether, 4,281 records were screened; 14 met the inclusion criteria. The data were synthesised using meta-ethnography. Four themes were identified: a shattered world, losing and regaining control, the role of health professionals and the power of cultures. Pregnancy termination for fetal abnormality can be considered as a traumatic event that women experience as individuals, in their contact with the health professional community, and in the context of their politico-socio-legal environment. The range of emotions and experiences that pregnancy termination for fetal abnormality generates goes beyond the abortion paradigm and encompasses a bereavement model. Coordinated care pathways are needed that enable women to make their own decisions and receive supportive care.

Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies.

OBJECTIVE: Pregnancy termination for foetal abnormality (TFA) can have significant psychological repercussions, but little is known about the coping strategies involved in dealing with TFA. This study examined the relationships between women's coping strategies and perinatal grief. METHOD: A total of 166 women completed a survey online. Coping and perinatal grief were measured using the Brief COPE and Short Perinatal Grief Scales. Data were analysed through multiple regression analyses. RESULTS: Despite using mostly adaptive coping strategies, women's levels of grief were high and varied according to obstetric and termination variables. Grief was predicted by behavioural disengagement, venting, planning, religion, self-blame, being recently bereaved, being childless at the time of TFA, not having had children/being pregnant since TFA and uncertainty about the decision to terminate the pregnancy. Acceptance and positive reframing negatively predicted grief. CONCLUSION: Identifying women vulnerable to poor psychological adjustment and promoting coping strategies associated with lower levels of grief may be beneficial. This could be addressed through information provision and interventions such as Cognitive Behavioural Therapy or Acceptance and Commitment Therapy.

Strengthening socio-emotional competencies in a school setting: data from the Pyramid project.

BACKGROUND: Development of socio-emotional competencies is key to children's successful social interaction at home and at school. AIMS: This study examines the efficacy of a UK primary school-based intervention, the Pyramid project, in strengthening children's socio-emotional competencies. SAMPLE: Participants were 385 children from seven schools in two UK cities. All children were aged 7-8 years and in school Year 3. Children were screened for socio-emotional difficulties through the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) and a multi-agency meeting of relevant professionals before being allocated to attend a Pyramid Club intervention (n= 103) or a comparison group (n= 282). METHOD: A 2 × 2 mixed-model design was used: group (intervention group vs. comparison group) × 2 time points (pre- vs. 12 weeks post-intervention) with repeated measures on the time factor to investigate the impact of the Pyramid Year 3 intervention. Teachers completed the SDQ-T4-16 for all children pre- and post-intervention to measure participants' socio-emotional health status. RESULTS: As measured by the two SDQ difficulty sub-scales of Emotional and Peer problems and the SDQ strength sub-scale of Prosocial behaviour, post-intervention improvements in the Pyramid attendee group were of greater magnitude than those of the comparison group. CONCLUSIONS: The Pyramid project intervention improves the socio-emotional health of vulnerable children through promoting positive outcomes as well as reducing socio-emotional deficits. These findings further support the inclusion of a salutogenic approach in promoting children's socio-emotional well-being.

Women's experiences of coping with pregnancy termination for fetal abnormality.

Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

Complementary medicine use in multi-ethnic paediatric outpatients.

OBJECTIVE: To determine the prevalence and determinants of complementary medicine (CM) use in a multi-ethnic paediatric outpatient population. METHODOLOGY: A parent-completed questionnaire survey of paediatric outpatients attending general and sub-specialist outpatient clinics at a North West London hospital during September to December 2005. RESULTS: Parents' use of CM for their children in this multi-ethnic population was higher than expected at 37%. Use was correlated with parental CM use and education but independent of ethnic group. Parental CM use and child's health status were significant predictors of child CM use. The main reason for using CM was word of mouth (45%) and the main source of information was friends and family (51%). The most popular treatments used for children were homeopathy and herbal medicine (used by 30% and 28% of CM users, respectively). 88% of CM was bought over the counter and 53% of CM use was not reported to their doctor. Parents also used traditional complementary remedies for their children. CONCLUSIONS: These results suggest that CM use in children is higher than previously estimated in the UK. This indicates the need for greater professional awareness of CM as part of clinical care. There is a need to acknowledge the beliefs that inform parents' decision-making process.

The Pyramid Club Primary School-Based Intervention: Evaluating the Impact on Children's Social-Emotional Health.

BACKGROUND: Children with poor social-emotional health are at risk of failing to reach their potential. METHOD: The impact of the Pyramid Club year 3 preventive intervention on children's social-emotional health was investigated. Children were allocated to an intervention or non-problem comparison group. RESULTS: Post-intervention both groups had improved Total Difficulty scores (Strengths and Difficulties Questionnaire) with the Pyramid group showing a significantly stronger effect size (r = .71) than the non-problem comparison group (r = .44). CONCLUSIONS: The Pyramid Club intervention improves the social-emotional health of vulnerable children. The need to evaluate such interventions and to extend research are discussed.

Promoting mental health in students: is there a role for sleep?

Independently both the role of being a student and reporting insufficient or unsatisfactory sleep have been shown to have deleterious consequences on mental health. However, few studies have examined the combined relationship between students' sleep patterns specifically with mental health in mind, and how individual psychological characteristics and situational factors can influence this relationship. The purpose of this research was to examine the relationship between sleep functioning and students' levels of perceived stress over the course of an exam period. Additionally, the influence of perfectionism (as an individual characteristic) and daytime sleep-related intrusive thoughts (sleep catastrophising) on sleep functioning and stress were also examined. Two assumptions were tested. Firstly, that stress would increase between baseline and the morning of the exam and secondly, that this relationship would be moderated by poor sleep functioning, sleep catastrophising and levels of perfectionism. Levels of stress, sleep functioning and sleep catastrophising were examined over a seven-day period in 48 Access to Higher Education students about to take an exam and 44 non-exam taking controls. For the exam group, levels of stress and sleep catastrophising increased between time-points. At baseline higher reported perfectionism predicted stress scores. Conversely, low perfectionism predicted high stress on the morning of the exam. Additionally, going to bed later and high levels of sleep catastrophising were also related to stress levels the morning of the exam. The results suggest an association between perfectionism and pre-exam stress, and are discussed in terms of mental health promotion for higher education students.