An investigation of treatment return after psychological therapy for depression and anxiety.

BACKGROUND: Some patients return for further psychological treatment in routine services, although it is unclear how common this is, as scarce research is available on this topic. AIMS: To estimate the treatment return rate and describe the clinical characteristics of patients who return for anxiety and depression treatment. METHOD: A large dataset (N=21,029) of routinely collected clinical data (2010-2015) from an English psychological therapy service was analysed using descriptive statistics. RESULTS: The return rate for at least one additional treatment episode within 1-5 years was 13.7%. Furthermore, 14.5% of the total sessions provided by the service were delivered to treatment-returning patients. Of those who returned, 58.0% continued to show clinically significant depression and/or anxiety symptoms at the end of their first treatment, while 32.0% had experienced a demonstrable relapse before their second treatment. CONCLUSIONS: This study estimates that approximately one in seven patients return to the same service for additional psychological treatment within 1-5 years. Multiple factors may influence the need for additional treatment, and this may have a major impact on service activity. Future research needs to further explore and better determine the characteristics of treatment returners, prioritise enhancement of first treatment recovery, and evaluate relapse prevention interventions.

Factors associated with low fruit and vegetable consumption among people with severe mental ill health.

Severe mental ill health (SMI) is associated with excess mortality, and poor diet is one associated modifiable risk factor. This study investigated factors associated with low consumption of fruit and vegetables among people with SMI (N = 9914). A total of 8.4% of participants ate no portions per day, while only 15% ate 5 + portions. Individuals who never consumed fruit and vegetables or ate < 5 portions per day were more likely to be male, younger than 65, unemployed, experience poorer general health, or perceive health as unimportant. Poor diet is common among people with SMI and tailored dietary improvement interventions are required.

Health-risk behaviours among people with severe mental ill health: understanding modifiable risk in the Closing the Gap Health Study.

BACKGROUND: People with severe mental ill health (SMI) experience some of the largest health inequalities of any sector within society. For these inequalities to be reduced, an understanding of the behavioural determinants of health in this population is needed. AIMS: Utilising data from the Closing the Gap Health Study, we aimed to assess the extent to which people with SMI report health-risk factors and behaviours, their interest in modifying them, and the factors associated with being motivated to modify these behaviours. METHOD: Adult (≥18 years old) participants were recruited via primary and secondary care in the English National Health Service. To be eligible, participants needed to have a documented diagnosis of schizophrenia, psychotic disorders or bipolar disorder. Data were collected by survey on demographics, general physical health, diet, physical activity, alcohol, smoking and body mass index. RESULTS: Between April 2016 and March 2020, n = 9914 participants were recruited. Among people with SMI, high rates of obesity (37.5%), infrequent physical activity (62.0%), not meeting current guidelines (≥5) for the consumption of fruit and vegetables (85.0%) and smoking (42.2%) were observed. However, most participants were motivated to reduce health-risk behaviours. Perceiving the importance of health-promoting behaviours, being of poorer general health and being female were significantly associated with being motivated to modify health-risk behaviours. CONCLUSIONS: Despite experiencing poor physical and mental health outcomes compared with the general population, and contrary to popular misconceptions, people with SMI perceive health as important and are motivated to make behavioural changes to improve health.

Exposure to behavioral regularities in everyday life predicts infants' acquisition of mental state vocabulary.

There are two broad views of children's theory of mind. The mentalist view is that it emerges in infancy and is possibly innate. The minimalist view is that it emerges more gradually in childhood and is heavily dependent on learning. According to minimalism, children initially understand behaviors rather than mental states, and they are assisted in doing so by recognizing repeating patterns in behavior. The regularities in behavior allow them to predict future behaviors, succeed on theory-of-mind tasks, acquire mental state words, and eventually, understand the mental states underlying behavior. The present study provided the first clear evidence for the plausibility of this view by fitting head cameras to 54 infants aged 6 to 25 months, and recording their view of the world in their daily lives. At 6 and 12 months, infants viewed an average of 146.5 repeated behaviors per hour, a rate consistent with approximately 560,000 repetitions in their first year, and with repetitions correlating with children's acquisition of mental state words, even after controlling for their general vocabulary and a range of variables indexing social interaction. We also recorded infants' view of people searching or searching for and retrieving objects. These were 92 times less common and did not correlate with mental state vocabulary. Overall, the findings indicate that repeated behaviors provide a rich source of information for children that would readily allow them to recognize patterns in behavior and help them acquire mental state words, providing the first clear evidence for this claim of minimalism. RESEARCH HIGHLIGHTS: Six- to 25-month-olds wore head cameras to record home life from infants' point-of-view and help adjudicate between nativist and minimalist views of theory-of-mind (ToM). Nativists say ToM is too early developing to enable learning, whereas minimalists say infants learn to predict behaviors from behavior patterns in environment. Consistent with minimalism, infants had an incredibly rich exposure (146.5/h, >560,000 in first year) to repeated behaviors (e.g., drinking from a cup repeatedly). Consistent with minimalism, more repeated behaviors correlated with infants' mental state vocabulary, even after controlling for gender, age, searches witnessed and non-mental state vocabulary.

Predictors of relapse and recurrence following cognitive behavioural therapy for anxiety-related disorders: a systematic review.

Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT for adult (18+) patients to enable the identification of "at-risk" patients who could potentially benefit from relapse prevention interventions. A systematic review and meta-analysis were conducted, including studies found in PsycINFO, PubMed, Scopus, and Web of Science, and through hand-searches of references lists and reverse citations. Nine studies met eligibility criteria (N = 532 patients). On average, 23.8% of patients experienced relapse following completion of CBT. A total of 21 predictors were identified and grouped into seven categories: residual symptoms; personality disorders; medication; clinical features; stressful life-events; degree of improvement; and demographics. A meta-analysis of residual symptoms as a predictor of relapse yielded a moderate but non-significant-pooled effect size (r = 0.35; 95% CI -0.21, 0.74, p =.08). Further research with adequately powered samples and standardised operationalisations of relapse are required to identify robust predictors.

Dynamic prediction and identification of cases at risk of relapse following completion of low-intensity cognitive behavioural therapy.

Objective: Low-intensity cognitive behavioural therapy (LiCBT) can help to alleviate acute symptoms of depression and anxiety, but some patients relapse after completing treatment. Little is known regarding relapse risk factors, limiting our ability to predict its occurrence. Therefore, this study aimed to develop a dynamic prediction tool to identify cases at high risk of relapse. Method: Data from a longitudinal cohort study of LiCBT patients was analysed using a machine learning approach (XGBoost). The sample included n = 317 treatment completers who were followed-up monthly for 12 months (n = 223 relapsed; 70%). An ensemble of XGBoost algorithms was developed in order to predict and adjust the estimated risk of relapse (vs maintained remission) in a dynamic way, at four separate time-points over the course of a patient's journey. Results: Indices of predictive accuracy in a cross-validation design indicated adequate generalizability (AUC range = 0.72-0.84; PPV range = 71.2-75.3%; NPV range = 56.0-74.8%). Younger age, unemployment, (non-)linear treatment responses, and residual symptoms were identified as important predictors. Discussion: It is possible to identify cases at risk of relapse and predictive accuracy improves over time as new information is collected. Early identification coupled with targeted relapse prevention could considerably improve the longer-term effectiveness of LiCBT.

Use of a head camera to examine maternal input and its relation to 10- to 26-month-olds' acquisition of mental and non-mental state vocabulary.

We examined the relation between maternal responsiveness and children's acquisition of mental and non-mental state vocabulary in 59 pairs of mothers and children aged 10 to 26 months as they engaged in a free-play episode. Children wore a head camera and responsiveness was defined as maternal talk that commented on the child's actions (e.g., when the child reached for or manipulated an object visible in the head camera). As hypothesized, maternal responsiveness correlated with both mental and non-mental state vocabulary acquisition in younger children (approximately 18 months and younger) but not older children. We posit a diminishing role for maternal responsiveness in language acquisition as children grow older.

Exploring relapse through a network analysis of residual depression and anxiety symptoms after cognitive behavioural therapy: A proof-of-concept study.

Objective: Many patients relapse within one year of completing effective cognitive behavioural therapy (CBT) for depression and anxiety. Residual symptoms at treatment completion have been demonstrated to predict relapse, and so this study used network analyses to improve specificity regarding which residual anxiety and depression symptoms predict relapse. Method: A cohort study identified relapse cases following low- and high-intensity CBT in a stepped care psychological therapy service. The sample included N = 867 "recovered" treatment completers that attended a six-month follow-up review. At follow-up, N = 93 patients had relapsed and N = 774 remained in-remission. Networks of final treatment session depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated for both sub-groups. Results: Qualitatively similar symptom networks were found. Difficulty concentrating was a highly central symptom in the relapse network, whilst of only average centrality in the remission network. In contrast, trouble relaxing was highly central in the remission network, whilst of only average centrality in the relapse network. Discussion: Identification of central residual symptoms holds promise in improving the specificity of prognostic models and the design of evidence-based relapse prevention strategies. The small sample of relapse cases limits this study's ability to draw firm conclusions.