Mental and Physical Multimorbidity Publications
Research papers published by our team
Authors - Emily Peckham, Panagiotis Spanakis, Paul Heron, Suzanne Crosland, Gordon Johnston, Elizabeth Newbronner, Ruth Wadman, Lauren Walker, Simon Gilbody
The COVID-19 pandemic has amplified pre-existing health inequalities and people with severe mental ill health (SMI) are one of the groups at greatest risk. In this study, we explored the effects of the pandemic and pandemic restrictions on people with SMI during the first year of the pandemic.
We conducted a longitudinal study in a sample of people with SMI. The inception survey was carried out between July and December 2020. Participants were then re-surveyed between January and March 2021. People were contacted by telephone and invited to take part in the study over the phone, online or by postal questionnaire. Across both waves we asked participants about their physical and mental health, health risk behaviors, well-being, loneliness, and employment status.
Three hundred and sixty-seven people with SMI completed the inception survey and 249 people completed the follow up. Whilst some people reported no change in their physical (77, 31%) or mental health (60, 24%) over the course of the pandemic 53 (21%) reported a continuing decline in physical health and 52 (21%) reported a continuing decline in mental health. Participants who maintained a daily routine or reported no decline in physical health were found to be associated with no deterioration in mental health (Daily routine OR 2.27, 95% CI 1.11–4.64; no reported physical health decline OR 0.54, 95% CI 0.17–0.70). Participants were less likely to be occupationally active in the first phase of the pandemic compared to before the pandemic and in the second phase of the pandemic. However, there was no one single experience of people with SMI and similar to studies in the general populations a range of different scenarios was experienced.
We observed a series of factors that might amplify pre-existing health inequalities. Health systems should be mindful of this, and should redouble efforts to set in place changes to practice and policy, which can mitigate these inequalities. Examples might include; raising awareness of the importance of ensuring that people with SMI receive an annual physical health check and supporting people to maintain a daily routine.
Authors - Elizabeth Newbronner, Panagiotis Spanakis, Ruth Wadman, Suzanne Crossland, Paul Heron, Gordon Johnston, Lauren Walker, Simon Gilbody, Emily Peckham
Aims To explore:
How satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services.
Materials and Methods
A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyze the quantitative data. The free text responses were analyzed thematically.
367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it. However, acceptability was influenced by several factors, and participants were more likely to report that they had received all the support they needed, when seen in person.
Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.
Authors - Paul Heron; Panagiotis Spanakis; Suzanne Crosland; Gordon Johnston; Elizabeth Newbronner; Ruth Wadman; Lauren Walker; Simon Gilbody; Emily Peckham
Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health.
We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.
In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29–34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03–5.91).
Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.
Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.
Authors - Emily Shoesmith, Panagiotis Spanakis, Emily Peckham, Paul Heron, Gordon Johnston, Lauren Walker, Suzanne Crosland, Elena Ratschen
Research has reported the benefits of companion animals for people with severe mental illness (SMI). However, this evidence base is fragmented and unclear. The COVID-19 pandemic presents an opportunity to explore the role of companion animals in the context of social distancing and isolation measures for people with SMI. Therefore, we aimed to investigate the links between mental and physical health and animal ownership in people with SMI and to explore animal owners’ perceptions related to human–animal interactions during the pandemic restrictions. A survey was conducted with a previously assembled cohort of individuals with SMI in the UK. The survey included previously validated and new bespoke items measuring demographics, and outcomes related to mental and physical health, and human–animal interactions. The survey also included a question inviting free-text responses, allowing participants to describe any experiences of their human–animal relationships during the pandemic. Of 315 participants who consented to participate, 249 (79%) completed the survey. Of these, 115 (46.2%) had at least one companion animal. Regression analyses indicated that animal ownership was not significantly associated with well-being and loneliness. However, animal ownership was associated with a self-reported decline in mental health (b = 0.640, 95% CI [0.102–1.231], p = 0.025), but no self-reported change in physical health. Thematic analysis identified two main themes relating to the positive and negative impact of animal ownership during pandemic restrictions. Animal ownership appeared to be linked to self-reported mental health decline in people with SMI during the second wave of the pandemic in the UK. However, the thematic analysis also highlighted the perceived benefit of animal ownership during this time. Further targeted investigation of the role of human–animal relationships and the perceived human–animal bond for human health is warranted.
Authors - Sebastian Hinde, Laura Bojke, Pete Coventry
Internationally, shifts to more urbanised populations, and resultant reductions in engagements with nature, have been a contributing factor to the mental health crisis facing many developed and developing countries. While the COVID-19 pandemic reinforced recent trends in many countries to give access to green spaces more weight in political decision making, nature-based activities as a form of intervention for those with mental health problems constitute a very small part of patient pathways of care. Nature-based interventions, such as ecotherapy, are increasingly used as therapeutic solutions for people with common mental health problems. However, there is little data about the potential costs and benefits of ecotherapy, making it difficult to offer robust assessments of its cost-effectiveness. This paper explores the capacity for ecotherapy to be cost-effective as a healthcare intervention. Using a pragmatic scoping review of the literature to understand where the potential costs and health benefit lie, we applied value of information methodology to identify what research is needed to inform future cost-effectiveness assessments. We show that there is the potential for ecotherapy for people with mild to moderate common mental health problems to be cost-effective but significant further research is required. Furthermore, nature-based interventions such as ecotherapy also confer potential social and wider returns on investment, strengthening the case for further research to better inform robust commissioning.
Authors - Panagiotis Spanakis, Emily Peckham , Ben Young, Paul Heron, Della Bailey, Simon Gilbody
Background and Aims
People with severe mental ill health smoke more and suffer greater smoking-related morbidity and mortality. Little is known about the effectiveness of behavioural interventions for smoking cessation in this group. This review evaluated randomized controlled trial evidence to measure the effectiveness of behavioural smoking cessation interventions (both digital and non-digital) in people with severe mental ill health.
Systematic review and random-effects meta-analysis. We searched between inception and January 2020 in Medline, EMBASE, PsycINFO, CINAHL, Health Management Information Consortium and CENTRAL databases.
Setting and participants
Randomized controlled trials (RCTs) assessing the effects of behavioural smoking cessation and reduction interventions in adults with severe mental ill health, conducted in any country, in either in-patient or community settings and published in English.
The primary outcome was biochemically verified smoking cessation. Smoking reduction and changes in mental health symptoms and body mass index (BMI) were included as secondary outcomes. Narrative data synthesis and meta-analysis were conducted and the quality of included studies was appraised using the risk of bias 2 (RoB2) tool.
We included 12 individual studies (16 articles) involving 1861 participants. The first meta-analysis (three studies, 921 participants) demonstrated effectiveness of bespoke face-to-face interventions compared with usual care across all time-points [medium-term: relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.38–3.81; long-term: RR = 1.58, 95% CI = 1.09–2.30]. The second (three studies, 275 participants) did not demonstrate any difference in effectiveness of bespoke digital on-line interventions compared with standard digital on-line interventions (medium-term: RR = 0.87, 95% CI = 0.17–4.46). A narrative overview revealed mixed results when comparing bespoke face-to-face interventions with other active interventions. The methodological quality of studies was mixed, with the majority having some concerns mainly around risk of selective reporting.
Face-to-face bespoke smoking cessation interventions for adults with severe mental ill health appear to be effective when compared with treatment as usual, but evidence is equivocal when compared with other active interventions. There is limited evidence comparing bespoke digital interventions with generic interventions, and we found no studies comparing them with usual treatment.
Authors - Emily Peckham, Victoria Allgar, Suzanne Crosland, Paul Heron, Gordon Johnston, Elizabeth Newbronner, Panagiotis Spanakis, Ruth Wadman, Lauren Walker and Simon Gilbody
People with severe mental ill health (SMI) experience a mortality gap of 15–20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities.
We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic.
367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22–2.07; adjusted OR for Age 0.99, 95%CI 0.98–1.00).
COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.
Coventry, P et al (2021) Nature-based outdoor activities for mental and physical health: systematic review and meta-analysis
Authors - Peter Coventry, Jennifer V.E.Brown, Jodi Pervin, Sally Brabyn, Rachel Pateman, Josefien Breedvelt, Simon Gilbody, Rachel Stancliffe, Rosemary McEachan, Piran C.L. White
Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood −0.64 (95% CI: 1.05 to −0.23), reducing anxiety −0.94 (95% CI: 0.94 to −0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect −0.52 (95% CI: 0.77 to −0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.
Authors - Han-I Wang, Lu Han, Rowena Jacobs, Tim Doran, Richard IG Holt, Stephanie L Prady, Simon Gilbody, David Shiers, Sarah Alderson, Catherine Hewitt, Jo Taylor, Charlotte EW Kitchen, Sue Bellass, Najma Siddiqi
Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.
To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.
This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.
There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.
Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
Authors - Panagiotis Spanakis, Paul Heron, Lauren Walker, Suzanne Crosland, Ruth Wadman, Elizabeth Newbronner, Gordon Johnstone, Simon Gilbody, Emily Peckham
Restrictions due to the COVID-19 pandemic have led to everyday reliance on digitalisation of life, including access to health care services. People with severe mental ill health (SMI—e.g., bipolar or psychosis spectrum disorders) are at greater risk for digital exclusion and it is unknown to what extent they adapted to online service delivery. This study explored use of the Internet and digital devices during the pandemic restrictions and its association with physical and mental health changes.
Methods: Three hundred sixty seven adults with an SMI diagnosis completed a survey (online or offline) and provided information on access to Internet connexion and devices, internet knowledge, online activities, and barriers to using the Internet. They also self-reported changes in mental and physical health since the beginning of the pandemic restrictions.
During the pandemic restrictions 61.6% were limited or non-users of the Internet. The majority had access to the Internet and digital devices but around half reported knowledge deficits. Most common activities were accessing information and entertainment (88.9%), staying in touch with friends and families (84.8%), and purchasing goods (other than food) (84.3%). Most common barriers were finding the Internet “not interesting” (28.3%) or “too difficult” (27.9%), as well as “security concerns” (22.1–24.3%). Using the Internet “a lot” (vs. “just a bit or not at all”) during the pandemic was associated with younger age (18–30: Adj ORs 4.76; 31–45: 6.39; Ps < 0.001; vs. 66+), having a diagnosis of bipolar disorder (compared to psychosis; Adj OR = 3.88, P < 0.001), or reporting a decline in mental health (compared to no decline; Adj OR = 1.92, P = 0.01).
Most people with SMI were limited or non-users of the Internet during the pandemic, which seems to be mainly attributable to lack of interest and skills, rather than lack of devices or connectivity. Older adults with psychosis should be the focus of interventions to support digital engagement in people with SMI.
Authors - Mariya Geneshka, Peter Coventry, Joana Cruz, Simon Gilbody
There is growing interest in the ways natural environments influence the development and progression of long-term health conditions. Vegetation and water bodies, also known as green and blue spaces, have the potential to affect health and behaviour through the provision of aesthetic spaces for relaxation, socialisation and physical activity. While research has previously assessed how green and blue spaces affect mental and physical wellbeing, little is known about the relationship between these exposures and health outcomes over time. This systematic review summarised the published evidence from longitudinal observational studies on the relationship between exposure to green and blue space with mental and physical health in adults. Included health outcomes were common mental health conditions, severe mental health conditions and noncommunicable diseases (NCDs). An online bibliographic search of six databases was completed in July 2020. After title, abstract and full-text screening, 44 eligible studies were included in the analysis. Depression, diabetes and obesity were the health conditions most frequently studied in longitudinal relationships. The majority of exposures included indicators of green space availability and urban green space accessibility. Few studies addressed the relationship between blue space and health. The narrative synthesis pointed towards mixed evidence of a protective relationship between exposure to green space and health. There was high heterogeneity in exposure measures and adjustment for confounding between studies. Future policy and research should seek a standardised approach towards measuring green and blue space exposures and employ theoretical grounds for confounder adjustment.
Authors - Qi Wu, Simon Gilbody, Jinshuo Li, Han-I Wang, Steve Parrott
People with mental disorders are more likely to smoke than the general population. The objective of this study is to develop a decision analytical model that estimates long-term cost-effectiveness of smoking cessation interventions in this population.
A series of Markov models were constructed to estimate average lifetime smoking-attributable inpatient cost and expected quality-adjusted life-years. The model parameters were estimated using a variety of data sources. The model incorporated uncertainty through probabilistic sensitivity analysis using Monte Carlo simulations. It also generated tables presenting incremental cost-effectiveness ratios of the proposed interventions with varying incremental costs and incremental quit rates. We used data from 2 published trials to demonstrate the model’s ability to make projections beyond the observational time frame.
The average smoker’s smoking-attributable inpatient cost was 3 times higher and health utility was 5% lower than ex-smokers. The intervention in the trial with a statistically insignificant difference in quit rate (19% vs 25%; P=.2) showed a 45% to 49% chance of being cost-effective compared with the control at willingness-to-pay thresholds of £20 000 to £30 000/quality-adjusted life-years. The second trial had a significant outcome (quit rate 35.9% vs 15.6%; P<.001), and the corresponding probability of the intervention being cost-effective was 65%.
This model provides a consistent platform for clinical trials to estimate the potential lifetime cost-effectiveness of smoking cessation interventions for people with mental disorders and could help commissioners direct resources to the most cost-effective programs. However, direct comparisons of results between trials must be interpreted with caution owing to their different designs and settings.
Authors - Peter A. Coventry, Ben Young, Abisola Balogun-Katang, Johanna Taylor, Jennifer V. E. Brown, Charlotte Kitchen, Ian Kellar, Emily Peckham, Sue Bellass, Judy Wright, Sarah Alderson, Jennie Lister, Richard I. G. Holt, Patrick Doherty, Claire Carswell, Catherine Hewitt, Rowena Jacobs, David Osborn, Jan Boehnke, and Najma Siddiqi
Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator's Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI.
Authors - Sally Ohlsen,Tom Sanders, Janice Connell, Emily Wood
Aims and objectives
To identify barriers and facilitators to implementing community nurses being trained as psychological wellbeing practitioners and integrating this practice into home-based primary care nursing, through key stakeholders’ perceptions.
Current drivers in UK primary care aim to increase access to mental health services and treatment, to achieve parity of esteem between physical and mental health care for patients who are housebound. However, there remains limited evidence on how to successfully implement this. Training community nurses as psychological wellbeing practitioners to offer mental health care alongside their current home-based services is one option.
A pluralistic qualitative study. This study followed the COREQ checklist for reporting qualitative research.
Twenty key stakeholders were purposively recruited and interviewed including twelve health professionals and eight patients. Semi-structured interviews were analysed using a theoretical thematic analysis informed by normalisation process theory concepts of coherence, cognitive participation, collective action and reflexive monitoring, to explore the barriers and facilitators to implementation.
Staff and patients reported high coherence and cognitive participation, valuing the integrated roles. Facilitators included the development of clearer referral pathways and increased mental health knowledge in the wider team. However, sustainability and current siloed healthcare systems were identified as barriers to implementation.
A key obstacle to long-term implementation was the practical structures and financial boundaries of siloed healthcare systems, making long-term sustainability unviable.
Relevance to clinical practice
Community nurses with additional mental health training can integrate these skills in practice and are valued by their team and patients offering holistic care to patients within their home and informal knowledge transfer to the wider team. However, long-term sustainability is required if this is to be adopted routinely. Further evidence is needed to better understand the positive outcomes to patients and potential cost savings.
Authors - Emily Peckham, Victoria Allgar, Suzanne Crosland, Paul Heron, Gordon Johnston, Elizabeth Newbronner, Elena Ratschen, Panagiotis Spanakis, Ruth Wadman, Lauren Walker and Simon Gilbody
Smoking rates are higher for people who use mental health services, which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with severe mental illness, before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Although some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.
Authors - Sue Bellass, Jennie Lister, Charlotte Emma Wray Kitchen, Lyndsey Kramer, Sarah Louise Alderson, Tim Doran, Simon Gilbody, Lu Han, Catherine Hewitt, Richard Ian Gregory Holt, Rowena Jacobs, Stephanie Louise Prady, David Shiers, Najma Siddiqi, Johanna Taylor
Diabetes is two to three times more prevalent in people with severe mental illness, yet little is known about the challenges of managing both conditions from the perspectives of people living with the co-morbidity, their family members or healthcare staff. Our aim was to understand these challenges and to explore the circumstances that influence access to and receipt of diabetes care for people with severe mental illness.
Framework analysis of qualitative semi-structured interviews with people with severe mental illness and diabetes, family members, and staff from UK primary care, mental health and diabetes services, selected using a maximum variation sampling strategy between April and December 2018.
In all, 39 adults with severe mental illness and diabetes (3 with type 1 diabetes and 36 with type 2 diabetes), nine family members and 30 healthcare staff participated. Five themes were identified: (a) Severe mental illness governs everyday life including diabetes management; (b) mood influences capacity and motivation for diabetes self-management; (c) cumulative burden of managing multiple physical conditions; (d) interacting conditions and overlapping symptoms and (e) support for everyday challenges. People living with the co-morbidity and their family members emphasised the importance of receiving support for the everyday challenges that impact diabetes management, and identified barriers to accessing this from healthcare providers.
More intensive support for diabetes management is needed when people's severe mental illness (including symptoms of depression) or physical health deteriorates. Interventions that help people, including healthcare staff, distinguish between symptoms of diabetes and severe mental illness are also needed.
Shoesmith, E. et al (2021) Supporting smoking cessation and preventing relapse following a stay in a smoke‐free setting: a meta‐analysis and investigation of effective behaviour change techniques
Authors - Emily Shoesmith, Lisa Huddlestone, Fabiana Lorencatto, Lion Shahab, Simon Gilbody, Elena Ratschen
Background and Aims
Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions.
Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel–Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as ‘promising’ in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions).
Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks–18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08–1.49, I2 = 42%]. Nine BCTs (including ‘pharmacological support’, ‘goal-setting (behaviour)’ and ‘social support’) were characterized as ‘promising’ in terms of probable effectiveness and feasibility.
A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.
Authors - Peter A. Coventry, Dean McMillan, Andrew Clegg, Lesley Brown, Christina van der Feltz-Cornelis, Simon Gilbody, Shehzad Ali
To evaluate if depression contributes, independently and/or in interaction with frailty, to loss of independence in instrumental activities of daily living (ADL) in older adults with frailty.
Longitudinal cohort study of people aged ≥75 years living in the community. We used multi-level linear regression model to quantify the relationship between depression (≥5 Geriatric Depression Scale) and frailty (electronic frailty index), and instrumental activities of daily living (Nottingham Extended Activities of Daily Living scale; range: 0–66; higher score implies greater independence). The model was adjusted for known confounders (age; gender; ethnicity; education; living situation; medical comorbidity).
553 participants were included at baseline; 53% were female with a mean age of 81 (5.0 SD) years. Depression and frailty (moderate and severe levels) were independently associated with reduced instrumental activities of daily living scores. In the adjusted analysis, the regression coefficient was -6.4 (95% CI: -8.3 to -4.5, p<0.05) for depression, -1.5 (95% CI: -3.8 to 0.9, p = 0.22) for mild frailty, -6.1 (95% CI: -8.6 to -3.6, p<0.05) for moderate frailty, and -10.1 (95% CI: -13.5 to -6.8, p<0.05) for severe frailty. Moreover, depression interacted with frailty to further reduce instrumental activities of daily living score in individuals with mild or moderate frailty. These relationships remained significant after adjusting for confounders.
Frailty and depression are independently associated with reduced independence in instrumental activities of daily living. Also, depression interacts with frailty to further reduce independence for mild to moderately frail individuals, suggesting that clinical management of frailty should integrate physical and mental health care.
Authors - Elizabeth Eddy, Paul Heron, Dean McMillan, Sarah Dawson, David Ekers, Nisha Hickin, Elizabeth Littlewood, Roz Shafran, Nicholas Meader, Simon Gilbody
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
To examine the effects of structured psychological interventions, based on cognitive behavioural therapy (CBT) techniques, compared to all comparators on loneliness in adolescents, adults, and older adults with diagnoses of common mental disorders, or at risk of loneliness.
To examine the effects of structured psychological interventions, based on CBT techniques, compared to all comparators on depression severity, anxiety severity, social connectedness, or quality of life in adolescents, adults, and older adults, with diagnoses of common mental disorders, or at risk of loneliness.
Buck, E.T et al (2020) Use of a modified World Café process to discuss and set priorities for a Community of Practice supporting implementation of ReQoL a new mental health and quality of life Patient Reported Outcome Measure (PROM)
Authors - Elizabeth Taylor Buck, Christine M. Smith, Amanda Lane, Anju Devianee Keetharuth, Tracey Young and Jo Cooke
Patient reported outcome measures (PROMs) are a means of assessing the quality and effectiveness of care from the patient’s perspective. However, the routine use of PROMs in clinical practice can be difficult to implement. New challenges arise at different stages of the implementation process and organisations need to invest time and financial resources into designing an appropriate strategy, information systems, providing technical support and preparing staff.
Recovering Quality of Life (ReQoL) is a PROM that was specifically designed to measure mental health service users’ perspectives of recovery and quality of life. It is a co-produced, service user-centred outcome measure tested by over 6000 mental health service users. It is able to detect change across a broad spectrum of mild to severe mental health conditions.
In May 2016 a licence to use the ReQoL measures became freely available to the NHS and publicly funded research. At the time of publication, 149 licences had been issued worldwide and eleven official translations had been made available. The team that developed ReQoL has continued to collaborate with mental health trusts across the country to support the implementation of ReQoL. The National Institute for Health Research and Applied Research Collaboration (NIHR ARC YHFootnote1), and the preceding NIHR CLAHRC-YH, along with the ReQoL development team have helped to guide and fund this work. The NIHR CLAHRC-YH supported two national events, the first of which was the launch of ReQoL at the Houses of Parliament in October 2016. More recently in November 2018, over 70 people, from 23 organisations, attended a second event focused on the development of a ReQoL Community of Practice.
Community of Practices (CoPs) have existed in sectors such as education and business for over 30 years , operating as networks and support groups for people who share a common set of problems or interests. Members of CoPs maintain and build links with each other for the purposes of social interaction, knowledge sharing, knowledge creation and identity building.
Authors - Jinshuo Li , Caroline Fairhurst , Emily Peckham , Della Bailey, Catherine Arundel , Catherine Hewitt , Paul Heron , Suzanne Crosland , Steve Parrott , Simon Gilbody , and SCIMITAR+ collaborative
Aims To evaluate the cost‐effectiveness of a specialist smoking cessation package for people with severe mental illness Design Incremental cost‐effectiveness analysis was undertaken from the UK National Health Service and Personal Social Services perspective over a 12 month time horizon. Total costs, including smoking cessation, healthcare and social services costs, and quality‐adjusted life years (QALYs), derived from EQ‐5D‐5L, collected from a randomised controlled trial, were used as outcome measures. Bootstrap technique was employed to assess the uncertainty. Setting Sixteen primary care and 21 secondary care mental health sites in England Participants Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n=526). Intervention and comparator A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomised, 261 were in UC group and 265 were in BSC group. Measurements BSC intervention cost was estimated from treatment log. Costs of UC, healthcare and social services, and EQ‐5D‐5L were collected at baseline, six‐ and 12‐month follow‐ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates. Findings The mean total cost in the BSC group was £270 (95% CI ‐£1,690 to £1,424) lower than in the UC group while the mean QALYs were 0.013 (95% CI ‐0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost‐effective at £20,000/QALY). Conclusions A bespoke smoking cessation package for people with severe mental illness is likely to be cost‐effective over 12 months compared with usual care provided by the UK's National Health Service and personal social services.