CAMHS to AMHS: How Satisfied are Young People with their Transition from Child to Adult Mental Health Services?
Cameron Meades | University of Warwick
Transitional care is a crucial component of mental health service provision; 25 000 young people (YP) under the care of Child and Adolescent Mental Health Services (CAMHS) reach the transition boundary with Adult Mental Health Services (AMHS) each year in the UK. The cumulative effect of changes within the social, educational and relational domains of YP’s lives make this a critical time period. The MILESTONE study followed transitioning youth over this period, collecting data on transition experiences and outcomes.
Data previously collected from the 8-country MILESTONE study was analysed using IBM SPSS Statistics. Descriptive frequency statistics were generated for baseline characteristics and outcome measures. Logistic regression using satisfaction scores (<8/10= 0; 8+/10= 1) were analysed using univariate/multivariate analyses to calculate odds ratios.
287/1005 YP were eligible for inclusion in analysis. UK YP were less satisfied than other EU YP, and those YP aged 18+ were more satisfied than those under 18. Higher YP-reported transition preparedness, desire for parental involvement, success of information transfer, and relationships with AMHS staff significantly increased satisfaction. Clinician-reported transition preparedness was not significant in predicting overall transition satisfaction. Multivariate analysis highlighted that, accounting for all other variables, country, age, YP-reported transition readiness and YP–AMHS clinician relationships were all significant (p <0.10) in increasing their satisfaction with transition.
The project highlights the importance of how YP perceive their transition preparedness, and the fostering of strong relationships with their new service providers, to improve satisfaction with mental health services in the future.
Spatial Navigation Testing for Dementia Diagnosis in a Setting of Low Literacy and Multilingualism
Felicity Davies | University of Warwick
There are over 2.9 million people living with Alzheimer’s disease in India. Alzheimer’s is a global disease characterized by progressive cognitive decline, the extent of which is assessed to aid diagnosis. Since the Indian population has a diverse range of schooling and language ability, traditional measures of cognitive decline may not be appropriate. Tools that assess cognitive changes in skills obtained outside a formal learning environment are likely to have more diagnostic benefit. The aim of the project is to aid in the development of screening tools for cognitive decline that are effective for patients with low literacy levels.
Patients with dementia and healthy controls were recruited from outpatient clinics at NIMHANs, Bengaluru. Each participant completed an ACE-III assessment and a questionnaire on spatial navigation.
16 patients and 28 healthy controls were recruited. The average ACE-III score was 51 for patients and 86 for controls out of a possible 100. The average spatial navigation score was 61% for patients and 94% for controls. This showed a statistically significant difference (p < 0.001) in perceived navigational skill between patients and controls.
Significant differences between the self-perceived navigational skill of patients and controls were observed, with a higher number of self-reported difficulties within the patient group. This adds to the growing evidence that spatial navigation assessment may act as an appropriate substitute for existing cognitive tests. Future research will need to focus on cross-cultural cooperation to devise more in-depth navigational assessments.
Prevalence of Amnesia in Individuals Committing Crime: a Systematic Review & Meta-Analysis
George Hawker | University of Warwick
Claims of amnesia have been used as a legal defence by those committing criminal offences. However, the most recent review of the prevalence of these claims was conducted over 30 years ago. Given the legal implications of a diminished criminal responsibility it is imperative to fully appreciate the circumstances surrounding such claims. The primary aim of this systematic review was to provide updated pooled prevalence estimate of amnesia in those convicted of committing crimes. Furthermore, to determine any possible sources of heterogeneity, we aimed to perform subgroup analysis of relevant contributing factors e.g. crime committed, age.
A systematic search of the literature was conducted through the following databases: PsycINFO (1806 - Oct 2019), Embase (1947 - 2019), Ovid MEDLINE(R) (1946 - Oct 2019), Web of Science (all years), Scopus (all years). This review was carried out in concordance with the PROSPERO protocol CRD42019154401. Meta-analysis and subgroup analysis of eligible studies were then performed. Pooled prevalence estimates were calculated using the metaprop command in STATA 16.0. Forest plots were constructed to present prevalence estimates with 95 % confidence intervals (CI) and assigned study weights. Eligible full-texts were quality assessed using the Joanna Briggs Institute (JBI) Appraisal Checklist for Studies Reporting Prevalence Data.
17 eligible studies were included in quantitative synthesis, reflecting a total sample of 3206 persons. The overall pooled prevalence of amnesia was 32.02 % (95 % CI: 26.15 - 38.17 %, I2 = 91.12 %, p < 0.001). Subgroup analysis of prevalence by crime committed showed no significant differences (heterogeneity between groups p = 0.78 ). Similarly, claims of amnesia before or after trial showed no significant difference (heterogeneity between groups p = 0.74). This indicates that rates of claiming amnesia do not directly correlate with more severe crimes or the influence of a trial, respectively.
This study presents the first meta-analysis for prevalence of amnesia in criminal offences. However, the foremost limitation is the lack of objective diagnostic testing of amnesia claims which may have contributed to significant heterogeneity. Future work should focus on determining mechanisms of amnesia and improving diagnostic screening.
Can Improving Quality of Sleep Reduce the Symptoms of Cancer-Related Fatigue? A Systematic Review
Rogan Dean | University of Warwick
Cancer-related fatigue (CRF) is a debilitating condition that results in reduced quality of life for cancer patients. The relationship between tiredness and fatigue has been established in cancer patients and has been shown to be reciprocal, with tiredness influencing fatigue and vice versa. This aim of this study is to determine whether an improvement in sleep quality can ease the symptoms of CRF and whether this can support the theory that CRF symptoms stem from the effect of tiredness.
Three databases were searched resulting in an initial identification of 259 papers. The papers were filtered using an inclusion criteria, resulting in a final list of 20 papers for analysis. The remaining papers (20) were critically appraised using the CASP RCT checklist and assessed for bias using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials before being used in the systematic review.
Of the 20 papers, 9 used a form of cognitive behavioural therapy (CBT) to improve sleep, 3 papers used a sleep education program, 8 used an exercise program. The remaining interventions used were “energy and sleep enhancement” (EASE) intervention, Individualized Sleep Promotion Plan (ISPP), acupuncture, armodafinil, Cognitive behavioural stress management (CBSM) intervention and reflexology. In total, 14 papers showed an increase in sleep quality that also resulted in an improvement in fatigue symptoms.
Improving quality of sleep does ease the symptoms of CRF, however, the ‘chicken or the egg’ question regarding CRF and tiredness cannot be answered at this stage.
Sleep Quality and Duration and Development of Depressive Symptoms in Children and Adolescents: a Systematic Review of Prospective Studies
Tehreem Khan | University of Warwick
Sleep quality and duration play an integral part in brain development, learning, memory and various other cognitive functions whilst also determining overall wellbeing. Recent epidemiological data has found that sleep duration and quality is declining around the world leading to number of serious health consequences, namely depression and anxiety disorders. This trend is particularly rising in children and adolescent populations. Sleep disturbances have been shown to be a risk factor for the development of depression in children and adolescents. However, the directionality of this relationship has not been well studied or synthesised in these populations. Aim: To carry out a systematic review of the literature studying the prospective association between poor sleep quality and short sleep duration and the development of depressive symptoms in childhood and adolescents.
We performed a systematic search using PubMed, Embase, Web of science and Cochrane up to (October 20, 2019). Included studies were prospective, had a follow-up of ≥ 1year for incident outcomes, had sleep quality and/or quantity at baseline, and measures of incidence of low mood or anhedonia or anergia or irritability at follow up. Studies needed to include children or adolescents (12-18yrs) in the baseline analysis. Studies that matched this criterion were then included in the final qualitative synthesis.
Fourteen prospective studies were included in the final synthesis. Of these, seven studies primarily investigated sleep quantity/duration as an exposure. Four of these found that a reduction in baseline sleep duration significantly predicted onset of depression or worsening of depressive symptoms on validated sleep questionnaires. Studies which included sleep quality as the primary exposure also reported a significant longitudinal relationship between sleep quality and depression. Interestingly, primary sleep problems also resulted in worsening of depressive symptomatology in patients with existing diagnosed depression.
Poor sleep quality and decreased sleep duration may be risk factors in the development of depression in adolescents. However, definitive conclusions cannot be made due to variance between study designs and cohort samples. Therefore, in order to further clarify the directionality of this relationship, further studies that improve on the current designs will be needed.