The outcome of an attachment-based infant mental health therapeutic play programme on infant temperament, parent-infant relationship & maternal reflective functioning

AimsIn the Philippines, there is a need for preventive, early intervention programs for perinatal and infant mental health. This is the first local study that investigated an attachment-based, therapeutic play programme (Baby Bonding) on infant temperament, parent-infant relationship and maternal reflecting functioning.BackgroundThis study was an effort towards bridging the “10/90 gap in infant mental health research” wherein 90% of the world's infants are born in low- middle-income countries (Population Reference Bureau, 2013b) and “only 10% of the worldwide spending on health research is directed towards the problems that primarily affect the poorest 90% of the world's population (Tomlinson et al., 2014).MethodPhase I involved local validation of the Parent-Rated Outcome Measures (PROM)- Infant Characteristics Questionnaire (ICQ), Mother Object Relations Scale (MORS) and Parental Reflective Functioning Questionnaire (PRFQ).Healthy mother-baby dyads, from the low socio-economic stratum, were screened using Parent Evaluation of Developmental Status (PEDS) and Hospital and Anxiety Depression Scale (HADS).Phase II carried out randomized controlled design wherein mother-baby dyads were enrolled either in the usual care group or the 6-weekly Baby Bonding intervention.Result102 mothers answered the PROM. Their responses constituted the training set of the study tools. Baseline responses of the mothers from the usual care (N = 51) and intervention (N = 53) groups formed the evaluation set for the Filipino- translated instruments. In both the training and evaluation sets, if certain identified questions were to be removed from the PROM, better and acceptable Cronbach values were consistently generated.There were no statistical differences on parent-infant relationship and reflective functioning between the usual care and intervention group. There was movement of the intervention group from high-challenging onto intermediate to low-levels of challenging temperament in the dull-dimension of the ICQ after 6 sessions. In comparison, infants in the control group remained in the high-challenging temperament after 6 weeks of usual care.ConclusionLinguistically validated study instruments (ICQ and MORS) provided accurate assessments of infant temperament and parent-child relationship. The Filipino-translated PRFQ has limited validity in evaluating parental reflective functioning (RF). “On-line” measures that video mother-baby interactions could have better captured changes in RF. As measured by the dull dimension of the ICQ, the Baby Bonding programme improved sociability of the infants (7 months or younger).

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Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.128470 ◽

2013 ◽

Vol 203 (5) ◽

pp. 350-357 ◽

Cited By ~ 33

Author(s):

Claire Henderson ◽

Elaine Brohan ◽

Sarah Clement ◽

Paul Williams ◽

Francesca Lassman ◽

...

Keyword(s):

Mental Health ◽

Randomised Controlled Trial ◽

Usual Care ◽

Decision Aid ◽

Controlled Trial ◽

Intervention Group ◽

Decisional Conflict ◽

Full Time ◽

Randomised Controlled

BackgroundMany mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request ‘reasonable adjustments’. There have been no intervention studies to support decisionmaking about disclosure to an employer.AimsTo determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid.MethodIn this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014).ResultsWe recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement −22.7 (s.d. = 15.2) v. −11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03).ConclusionsThe observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.

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Infant Mental Health Research in Africa: a call for action for research in the next 10 years

Global Mental Health ◽

10.1017/gmh.2015.4 ◽

2015 ◽

Vol 2 ◽

Cited By ~ 2

Author(s):

Mark Tomlinson ◽

Barak Morgan

Keyword(s):

Mental Health ◽

Maternal Depression ◽

Health Research ◽

Infant Development ◽

Mental Health Research ◽

Infant Mental Health ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Background.Less than 3% of articles published in the peer reviewed literature include data from low- and middle-income countries – where 90% of the world's infants live.Methods.In this paper, we discuss the context of infancy in Africa and the conditions of adversity obtaining in Africa.Results.We discuss the implications of poverty on parenting, and linked to this outline the impact of maternal depression on infant development.Conclusions.We outline three features of the field of infant mental health research in Africa, and issue a call for action about what we believe is needed in order to develop the field in the next decade.

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DEVELOPMENTALLY INFORMED PSYCHOTHERAPEUTIC WORK WITH CHILDREN AND ADOLESCENTS: APPLICATION OF INFANT MENTAL HEALTH RESEARCH

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2020.07.312 ◽

2020 ◽

Vol 59 (10) ◽

pp. S74-S75

Author(s):

Shilpa Sachdeva ◽

Nathaniel Donson

Keyword(s):

Mental Health ◽

Children And Adolescents ◽

Health Research ◽

Mental Health Research ◽

Infant Mental Health

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Web-based Therapy Plus Support by a Coach in Depressed Patients Referred to Secondary Mental Health Care: Randomized Controlled Trial

JMIR Mental Health ◽

10.2196/mental.8510 ◽

2018 ◽

Vol 5 (1) ◽

pp. e5 ◽

Cited By ~ 5

Author(s):

Simon Hatcher ◽

Robyn Whittaker ◽

Murray Patton ◽

Wayne Sylvester Miles ◽

Nicola Ralph ◽

...

Keyword(s):

Mental Health ◽

Randomized Controlled Trial ◽

Usual Care ◽

Controlled Trial ◽

Qualitative Interviews ◽

Intervention Group ◽

Control Group ◽

Web Based ◽

Randomized Controlled

Background The evidence for the effectiveness of Web-based therapies comes mainly from nonclinical populations, with a few studies in primary care. There is little evidence from patients referred to secondary mental health care with depression. Adherence to Web-based therapies is often poor. One way to increase this is to create a new health service role of a coach to guide people through the therapy. Objective This study aimed to test in people referred to secondary care with depression if a Web-based therapy (The Journal) supported by a coach plus usual care would be more effective in reducing depression compared with usual care plus an information leaflet about Web-based resources after 12 weeks. Methods We conducted a randomized controlled trial with two parallel arms and a process evaluation that included structured qualitative interviews analyzed using thematic analysis. The coach had a background in occupational therapy. Participants were recruited face-to-face at community mental health centers. Results We recruited 63 people into the trial (intervention 35, control 28). There were no statistically significant differences in the change from baseline in Patient Health Questionnaire-9 (PHQ-9) scores at 12 weeks comparing The Journal with usual care (mean change in PHQ-9 score 9.4 in the intervention group and 7.1 in the control group, t41=1.05, P=.30; mean difference=2.3, 95% CI −2.1 to 6.7). People who were offered The Journal attended on average about one less outpatient appointment compared with usual care, although this difference was not statistically significant (intervention mean number of visits 2.8 (SD 5.5) compared with 4.1 (SD 6.7) in the control group, t45=−0.80, P=.43; mean difference=1.3, 95% CI −4.5 to 2.0). The process evaluation found that the mean number of lessons completed in the intervention group was 2.5 (SD=1.9; range=0-6) and the number of contacts with the coach was a mean of 8.1 (SD=4.4; range=0-17). The qualitative interviews highlighted the problem of engaging clinicians in research and their resistance to recruitment: technical difficulties with The Journal, which prevented people logging in easily; difficulty accessing The Journal as it was not available on mobile devices; participants finding some lessons difficult; and participants saying they were too busy to complete the sessions. Conclusions The study demonstrated that it is feasible to use a coach in this setting, that people found it helpful, and that it did not conflict with other care that participants were receiving. Future trials need to engage clinicians at an early stage to articulate where Web-based therapies fit into existing clinical pathways; Web-based therapies should be available on mobile devices, and logging in should be easy. The role of the coach should be explored in larger trials. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12613000015741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363351&isReview=true (Archived by WebCite at http://www.webcitation.org/6wEyCc6Ss).

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Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial (Preprint)

10.2196/preprints.20790 ◽

2020 ◽

Author(s):

David Wiljer ◽

Jenny Shi ◽

Brian Lo ◽

Marcos Sanches ◽

Elisa Hollenberg ◽

...

Keyword(s):

Mental Health ◽

Usual Care ◽

Help Seeking ◽

Primary Outcome ◽

Controlled Trial ◽

Intervention Group ◽

Postsecondary Students ◽

Health And Wellness ◽

Web App ◽

The Impact

BACKGROUND Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research. OBJECTIVE The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada. METHODS A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy. RESULTS A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001). CONCLUSIONS Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy. CLINICALTRIAL ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.6446

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A bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health: the SCIMITAR+ RCT

Health Technology Assessment ◽

10.3310/hta23500 ◽

2019 ◽

Vol 23 (50) ◽

pp. 1-116 ◽

Cited By ~ 1

Author(s):

Emily Peckham ◽

Catherine Arundel ◽

Della Bailey ◽

Suzanne Crosland ◽

Caroline Fairhurst ◽

...

Keyword(s):

Mental Health ◽

Smoking Cessation ◽

Usual Care ◽

Usual Care Group ◽

Primary Outcome ◽

Intervention Group ◽

Health Technology ◽

Care Group ◽

Quit Smoking ◽

Severe Mental Ill Health

Background There is a high prevalence of smoking among people with severe mental ill health (SMI). Helping people with SMI to quit smoking could improve their health and longevity, and reduce health inequalities. However, those with SMI are less likely to access and engage with routine smoking cessation services than the general population. Objectives To compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual stop smoking services for people with SMI. Design A pragmatic, two-arm, individually randomised controlled trial. Setting Primary care and secondary care mental health services in England. Participants Smokers aged ≥ 18 years with SMI who would like to cut down on or quit smoking. Interventions A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual care. Main outcome measures The primary outcome was self-reported, CO-verified smoking cessation at 12 months. Smoking-related secondary outcomes were self-reported smoking cessation, the number of cigarettes smoked per day, the Fagerström Test for Nicotine Dependence and the Motivation to Quit questionnaire. Other secondary outcomes were Patient Health Questionnaire-9 items, Generalised Anxiety Disorder Assessment-7 items and 12-Item Short-Form Health Survey, to assess mental health and body mass index measured at 6 and 12 months post randomisation. Results The trial randomised 526 people (265 to the intervention group, 261 to the usual-care group) aged 19 to 72 years (mean 46 years). About 60% of participants were male. Participants smoked between 3 and 100 cigarettes per day (mean 25 cigarettes per day) at baseline. The intervention group had a higher rate of exhaled CO-verified smoking cessation at 6 and 12 months than the usual-care group [adjusted odds ratio (OR) 12 months: 1.6, 95% confidence interval (CI) 0.9 to 2.8; adjusted OR 6 months: 2.4, 95% CI 1.2 to 4.7]. This was not statistically significant at 12 months (p = 0.12) but was statistically significant at 6 months (p = 0.01). In total, 111 serious adverse events were reported (69 in the BSC group and 42 in the usual-care group); the majority were unplanned hospitalisations due to a deterioration in mental health (n = 98). The intervention is likely (57%) to be less costly but more effective than usual care; however, this result was not necessarily associated with participants’ smoking status. Limitations Follow-up was not blind to treatment allocation. However, the primary outcome included a biochemically verified end point, less susceptible to observer biases. Some participants experienced difficulties in accessing nicotine replacement therapy because of changes in service provision. Efforts were made to help participants access nicotine replacement therapy, but this may have affected participants’ quit attempt. Conclusions People with SMI who received the intervention were more likely to have stopped smoking at 6 months. Although more people who received the intervention had stopped smoking at 12 months, this was not statistically significant. Future work Further research is needed to establish how quitting can be sustained among people with SMI. Trial registration Current Controlled Trials ISRCTN72955454. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 50. See the NIHR Journals Library website for further project information.

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