Imperial College London

Dr Lindsay H. Dewa

Faculty of MedicineSchool of Public Health

Research Associate



+44 (0)20 7594 0815l.dewa




328Reynolds BuildingCharing Cross Campus





Publication Type

12 results found

Dewa L, Lavelle M, Pickles K, Jaques J, Kalorkoti C, Pappa S, Aylin Pet al., Young adults’ perceptions of using wearables, social media and other technologies to detect worsening mental health: a qualitative study, PLoS One, ISSN: 1932-6203

BackgroundTechnological interventions may help support and improve mental health. However young peoples’ perspectives on using different technologies to detect deteriorating mental health in those already diagnosed with a mental health condition is lacking. The study aim was to explore the perspectives of young patients on the feasibility and acceptability of using wearables, social media and technologies to detect mental health deterioration. Methods The study was co-produced with young adults with past mental health difficulties. Semi-structured interviews were conducted with young adults with a severe mental health condition in a private room at a community mental health site. Data was triangulated by comparing codes and ideas across the two co-researchers and two researchers over two virtual meetings. Themes were finalised and presented in a thematic map. ResultsSixteen participants were interviewed (81% female). There were four main themes: dealing with mental health symptoms, signs of mental health deterioration, technology concerns and technological applications to identify worsening mental health. Wearables and mobile apps were considered acceptable and feasible to detect mental health deterioration in real-time if they could measure changes in sleep patterns, mood or activity levels as signs of deterioration. Getting help earlier was deemed essential particularly in reference to dissatisfaction with the current non-technological mental health services. However, patients identified issues to consider before implementation including practicality, safeguarding and patient preference. ConclusionWearables and mobile apps could be viable technological options to help detect deterioration in young people in order to intervene early and avoid delay in accessing mental health services. However, immediate action following detection is required for the patient to trust and use the intervention.

Journal article

Dewa LH, Hassan L, Shaw J, Senior Jet al., 2018, The design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study, BMJ Open, Vol: 8, ISSN: 2044-6055

Objective: Insomnia is highly prevalent in prisoners and is a risk factor for poor mental well-being, depression, suicidality and aggression, all common concerns in this vulnerable population. Improving sleep management options in prison offers the potential to impact positively on a number of these common risk factors. The study aim was to design a treatment pathway for insomnia in prisons informed by stakeholders with professional or lived experience of insomnia and prison-based interventions.Design: A modified Delphi technique, adapted to the stakeholder (either receiving controlled feedback online or face to face on a series of statements), was used over three rounds to gain consensus on a final treatment pathway design.Participants: Academic sleep researchers, prison staff and prisoners were invited to develop the treatment pathway.Results: Fifteen stakeholders took part in round 1 and thirteen in round 2. There were six statements of contention that comprised concerns over the inclusion of sleep observations, sleep restriction therapy and promethazine. Consensus was high (>80%). Thirteen stakeholders agreed the final pathway in round 3. The final treatment pathway comprised a standardised stepped-care approach for insomnia in prison populations. The pathway resulted in five main stages: (1) transition from community; (2) detection and assessment; (3) treatment for short-term insomnia; (4) treatment for long-term insomnia and (5) transition from prison to community or another establishment.Conclusions: The treatment pathway is designed to promote early detection of insomnia, potentially reducing unnecessary prescriptions and medication trading, misuse and diversion in the prison setting. It should make a substantial difference in reducing the large number of sleep complaints and positively impact on prisoners, staff and the prison environment. Specifically, improving sleep should have a positive impact on prisoners’ mental and physical well-being and a

Journal article

Dewa LH, Cecil E, Eastwood L, Darzi A, Aylin Pet al., 2018, Indicators of deterioration in young adults with serious mental illness: a systematic review protocol, Systematic Reviews, Vol: 7, ISSN: 2046-4053

BackgroundThe first signs of serious mental illnesses (SMIs) including schizophrenia, bipolar disorder and major depression are likely to occur before the age of 25. The combination of high prevalence of severe mental health symptoms, inability to recognise mental health deterioration and increased likelihood of comorbidity in a complex transitional young group makes detecting deterioration paramount. Whilst studies have examined physical and mental health deterioration in adults, no systematic review has examined the indicators of mental and physical deterioration in young adults with SMI. The study aim is to systematically review the existing evidence from observational studies that examine the indicators of mental and physical deterioration in young adults with SMI and highlight gaps in knowledge to inform future research.MethodsSeven databases including CINHAL, MEDLINE, Embase, PsycINFO, Health Management Information Consortium, Cochrane databases and Web of Science will be searched against five main facets (age, serious mental illness, sign, deterioration and patient) and a subsequent comprehensive list of search terms. Searches will be run individually in each database to reflect each unique set of relevant subject headings and appropriate MeSH terms. Inclusion and exclusion criteria were developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction and appraisal, to ensure reliability. A narrative synthesis of the data will also be conducted.DiscussionThis systematic review will likely make a significant contribution to the field of mental health and help inform future research pertaining to interventions that help highlight deteriorating patients. This may vary depending on the patient group, mental illness or deterioration type.Systematic review registrationPROSPERO CRD42017075755

Journal article

Dewa LH, Murray K, Thibaut B, Ramtale C, Adam S, Darzi A, Archer Set al., 2018, Identifying research priorities for patient safety in mental health: an international expert Delphi study, BMJ Open, Vol: 8, ISSN: 2044-6055

Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health.Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements.Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included.Main outcome measures Agreement in research priorities on a five-point scale.Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important.Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this.

Journal article

Dewa LH, Hassan L, Shaw JJ, Senior Jet al., 2017, Insomnia management in prisons in England and Wales: a mixed-methods study, JOURNAL OF SLEEP RESEARCH, Vol: 26, Pages: 322-329, ISSN: 0962-1105

Journal article

Dewa LH, Hassan L, Shaw JJ, Senior Jet al., 2017, Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England, SLEEP MEDICINE, Vol: 32, Pages: 129-136, ISSN: 1389-9457

Objective:To investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England.Methods:A cross-sectional study of 237 prisoners aged 18–72 years, across two male prisons and one female prison in North England. We used the Sleep Condition Indicator to measure probable DSM-V insomnia disorder (ID) and the Pittsburgh Sleep Quality Index to examine sleep quality. Multiple demographic, sleep, clinical and forensic self-reported measures were recorded to identify any associations with insomnia.Results:Overall, the prevalence of possible DSM-V ID was 61.6% (95% CI, 55.5%–67.8%). Subjective poor sleep quality was reported by 88.2% (95% CI, 84.1%–92.3%). Seven in ten (70.6%) female prisoners had possible DSM-V ID (95% CI, 64.8%–76.4%). Multivariable logistic regression analysis, adjusting for gender and age, indicated odds of having possible ID in prison were increased for the following factors: history of physical ill-health (OR = 3.62, 95% CI, 1.31–9.98); suicidality (OR = 2.79, 95% CI,, previously asked for help for insomnia (OR = 2.58, 95% CI, 1.21–5.47), depression (OR = 2.06, 95% CI 1.31–3.24), greater endorsement of dysfunctional beliefs about sleep (OR = 1.50, 95% CI, 1.21–1.87), poor sleep hygiene (OR = 1.11, 95% CI, 1.04–1.19), and problematic prison environment (eg, noise, light or temperature) (OR = 1.07, 95% CI, 1.02–1.12).Conclusions:For the first time we have established the prevalence and associated factors of insomnia in a large sample of adult English prisoners. ID and poor sleep quality are common, especially in female prisoners. These findings emphasize/amplify the need for dedicated treatment pathways to improve screening, assessment and treatment of insomnia in prison.

Journal article

D'Lima D, Archer SA, Thibaut B, Ramtale S, Dewa L, Darzi Aet al., 2016, A systematic review of Patient Safety in Mental Health: a protocol based on the Inpatient Setting, Systematic Reviews, Vol: 5, ISSN: 2046-4053

Background Despite the growing international interest in patient safety as a discipline, there has been a lack of exploration of its application to mental health. It cannot be assumed that findings based upon physical health in acute care hospitals can be applied to mental health patients, disorders and settings. To the authors’ knowledge, there has only been one review of the literature that focuses on patient safety research in mental health settings, conducted in Canada in 2008. We have identified a need to update this review and develop the methodology in order to strengthen the findings and disseminate internationally for advancement in the field. This systematic review will explore the existing research base on patient safety in mental health within the inpatient setting. Methods To conduct this systematic review, a thorough search across multiple databases will be undertaken, based upon four search facets (“mental health”, “patient safety”, “research” and “inpatient setting”). The search strategy has been developed based upon the Canadian review accompanied with input from the National Reporting and Learning System (NRLS) taxonomy of patient safety incidents and the Diagnostic and Statistical Manual of Mental Disorders (5th edition). The screening process will involve perspectives from at least two researchers at all stages with a third researcher invited to review when discrepancies require resolution. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Quality assessment and data extraction of included articles will be conducted by at least two researchers. A data extraction form will be developed, piloted and iterated as necessary in accordance with the research question. Extracted information will be analysed thematically. Discussion We believe that this systematic review will make a significant contribution to the advancement of p

Journal article

Dewa LH, Kyle SD, Hassan L, Shaw J, Senior Jet al., 2015, Prevalence, associated factors and management of insomnia in prison populations: An integrative review, SLEEP MEDICINE REVIEWS, Vol: 24, Pages: 13-27, ISSN: 1087-0792

Journal article

Dewa LH, Kyle SD, Hassan L, Shaw J, Senior Jet al., 2014, Prevalence, associated factors and management of insomnia in prison populations: an integrated review, 22nd Congress of the European-Sleep-Research-Society, Publisher: WILEY-BLACKWELL, Pages: 134-134, ISSN: 0962-1105

Conference paper

Doyle M, Coid J, Archer-Power L, Dewa L, Hunter-Didrichsen A, Stevenson R, Wainwright V, Kallis C, Ullrich S, Shaw Jet al., 2014, Discharges to prison from medium secure psychiatric units in England and Wales, British Journal of Psychiatry, Vol: 205, Pages: 177-182, ISSN: 0007-1250

<jats:sec><jats:title>Background</jats:title><jats:p>Early findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Prospective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Nearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Findings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public.</jats:p></jats:sec>

Journal article

Dewa LH, Ireland CA, Ireland JL, 2014, Terror Management Theory: The Influence of Terrorism Salience on Anxiety and the Buffering of Cultural Worldview and Self-esteem, PSYCHIATRY PSYCHOLOGY AND LAW, Vol: 21, Pages: 370-384, ISSN: 1321-8719

Journal article

Dewa LH, Ireland CA, Gredecki N, 2011, The Interpersonal Style and Complementarity Between Crisis Negotiators and Forensic Inpatients, JOURNAL OF FAMILY VIOLENCE, Vol: 26, Pages: 277-283, ISSN: 0885-7482

Journal article

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