Imperial College London

Dr Lindsay H. Dewa

Faculty of MedicineSchool of Public Health

Advanced Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 0815l.dewa

 
 
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Location

 

328Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

35 results found

Dewa L, Roberts L, Choong E, Crandell C, Demkowicz O, Ashworth E, Branquinho C, Scott Set al., 2024, The impact of COVID-19 on young people’s mental health, wellbeing and routine from a European perspective: a co-produced qualitative systematic review, PLoS One, ISSN: 1932-6203

Background:The impact of the Covid-19 pandemic on young people’s (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP’s (aged 10-24) mental health and wellbeing across Europe. Methods and findings:We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP’s (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n=50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n=33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP’s mental health

Journal article

Dewa L, Thibaut B, Pattison N, Campbell S, Woodcock T, Aylin P, Archer Set al., 2024, Treating insomnia in people who are incarcerated: a feasibility study of a multi-component treatment pathway, Sleep Advances, ISSN: 2632-5012

Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardised, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomised controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-subjects pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioural therapy for insomnia (CBTi). Assessment measures for insomnia, wellbeing, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to post-treatment in insomnia severity (d=-1.81, 95% CIs 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, wellbeing, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted.

Journal article

Dewa L, Broyd J, Hira R, Dudley A, Hafferty J, Bates R, Aylin Pet al., 2023, A service evaluation of passive remote monitoring technology for patients in a high-secure forensic psychiatric hospital: a qualitative study, BMC Psychiatry, Vol: 23, ISSN: 1471-244X

Background:Technology has the potential to remotely monitor patient safety in real-time that helps staff and without disturbing the patient. However, staff and patients’ perspectives on using passive remote monitoring within an inpatient setting is lacking. The study aim was to explore stakeholders’ perspectives about using Oxehealth passive monitoring technology within a high-secure forensic psychiatric hospital in the UK as part of a wider mixed-methods service evaluation.Methods:Semi-structured interviews were conducted with staff and patients with experience of using Oxehealth technology face-to-face within a private room in Broadmoor Hospital. We applied thematic analysis to the data of each participant group separately. Themes and sub-themes were integrated, finalised, and presented in a thematic map. Design, management, and analysis was meaningfully informed by both staff and patients.Results:Twenty-four participants were interviewed (n = 12 staff, n = 12 patients). There were seven main themes: detecting deterioration and improving health and safety, “big brother syndrome”, privacy and dignity, knowledge and understanding, acceptance, barriers to use and practice issues and future changes needed. Oxehealth technology was considered acceptable to both staff and patients if the technology was used to detect deterioration and improve patient’s safety providing patient’s privacy was not invaded. However, overall acceptance was lower when knowledge and understanding of the technology and its camera was limited. Most patients could not understand why both physical checks through bedroom windows, and Oxehealth was needed to monitor patients, whilst staff felt Oxehealth should not replace physical checks of patients as reassures staff on patient safety.Conclusions:Oxehealth technology is considered viable and acceptable by most staff and patients but there is still some concern about its possible intrus

Journal article

Papageorgiou V, Dewa L, Bruton J, Murray K, Hewlett N, Thamm W, Hamza H, Frumiento P, Steward R, Bradshaw M, Brooks-Hall E, Petretti S, Ewans S, Williams M, Chapko Det al., 2023, ‘Building Bridges’: reflections and recommendations for co-producing health research, Research Involvement and Engagement, ISSN: 2056-7529

Journal article

Dewa L, Pappa S, Mitchell L, Hadley M, Cooke J, Aylin Pet al., 2022, Reflections, impact and recommendations of a co-produced ecological momentary assessment (EMA) study with young people who have experience of suicidality and psychiatric inpatient care, European Psychiatry, Vol: 65, Pages: S252-S252, ISSN: 0924-9338

IntroductionPatient and public involvement (PPI) in suicide research is ethical, moral and can deliver impact. However, inconsistent reporting of meaningful PPI, and hesitancy in sharing power with people with experience of suicidality (i.e.co-researchers) in research makes it difficult to understand the full potential impact of PPI on the research, researchers and co-researchers.ObjectivesTo describe how our ecological momentary assessment (EMA) study, examining the sleep-suicide relationship in young psychiatric inpatients (aged 18-35) transitioning to the community, has been co-produced, whilst reflecting on impact, challenges, and recommendations.MethodsWe built on our experience of co-produced mental health research to conduct meaningful PPI in our study. Young adults with experience of psychiatric inpatient care and suicidality were appointed November 2020 to work across all research stages. Reflections on challenges, recommendations and impact have been collected throughout.ResultsThree young people became co-researchers. Researcher and co-researcher reflections indicated establishing and maintaining safe environments for open discussion, and continued communication (e.g.WhatsApp group) were vital to effectively share power and decision making. Safeguarding and support requirements for both co-researchers (e.g.individualised strategy) and researcher (e.g.clinical supervision) were particularly evident. To date, the co-produced recruitment poster, research documentation, and research article have demonstrated significant impact.ConclusionsThis is the first EMA study focused on suicide-sleep during transitions to be co-produced with young people with experience of suicidality. Co-producing suicide research is intensive, time-consuming, and challenging but makes a significant impact to the research, researchers, and co-researchers. We expect our learning will directly influence, and help others produce, meaningful co-produced suicide research.

Journal article

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2022, The Association Between Sleep Disturbance and Suicidality inPsychiatric Inpatients Transitioning to the Community: Protocolfor an Ecological Momentary Assessment Study, JMIR Research Protocols, Vol: 11, Pages: 1-12, ISSN: 1929-0748

Background:Patients are at high risk of suicidal behaviour and death by suicide immediately followingdischarge from an inpatient psychiatric hospital. Furthermore, there is a high prevalence ofsleep problems in inpatient settings which is associated with worse outcomes followinghospitalisation. However, it is unknown whether poor sleep is associated with suicidalityfollowing initial hospital discharge.Objective:Our study objective is to describe the ecological momentary assessment (EMA) studyprotocol that aims to examine the relationship between sleep and suicidality in dischargedpatients.Methods:Our study will use EMA design using a wearable device to examine the sleep-suiciderelationship during the transition from acute inpatient care to the community. Prospectivelydischarged inpatients aged 18-35 with a mental disorder (n=50) will be assessed foreligibility and recruited across two sites. Data on suicidal ideation, behaviour and imagery,non-suicidal self-harm and imagery, defeat, entrapment, and hopelessness, affect and sleepwill be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objectivesleep and daytime activity will be measured using the inbuilt MotionWare software.Questionnaires will be administered face-to-face at baseline and follow-up while data willalso be collected on the acceptability and feasibility of using the Pro-Diary V watch tomonitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality.Results:South Birmingham Research Ethics Committee (Ref: 21/WM/0128) approved the study onJune 28th 2021. We expect to see a relationship between poor sleep and post-dischargesuicidality. Results will be available in 2022.DiscussionThis protocol describes the first co-produced EMA study to examine the relationshipbetween sleep and suicidality, and to apply the IMV model in young patients transitioningfrom psychiatric

Journal article

Thompson R, Toledano M, Dewa L, Fisher HL, Kabba Z, Hussain Tet al., 2022, Adolescents’ thoughts and feelings about the local and global environment: a qualitative interview study, Child and Adolescent Mental Health, Vol: 27, Pages: 4-13, ISSN: 1475-357X

BackgroundDespite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents' thoughts and feelings about current environmental issues.MethodsSemi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14–18 years (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers' impressions to strengthen interpretations of the personal experiences of the interviewees.ResultsSix themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment’s future.ConclusionThe UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people’s voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people's mental health and identify factors that could prevent or alleviate distress.

Journal article

Dewa L, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2021, Quality social connection as an active ingredient in digital interventions for young people with depression and anxiety: systematic scoping review and meta-analysis, Journal of Medical Internet Research, Vol: 23, Pages: 1-22, ISSN: 1438-8871

BackgroundDisrupted social connections may negatively impact youth mental health. In contrast, sustained quality social connections (QSC) can improve mental health outcomes. However, few studies have examined how these quality connections impact depression and anxiety outcomes within digital interventions, and conceptualisation is limited.ObjectiveThe study aim was to conceptualise, appraise and synthesise evidence on quality social connection within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people (14-24).MethodsA systematic scoping review and meta-analysis was conducted using the Johanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Medline, Embase, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched against a comprehensive combination of key concepts on 24th June 2020. Search concepts included young people, digital intervention, depression/anxiety, and social connection. Google was also searched. One reviewer independently screened abstracts/titles and full-text and 10% were screened by a second reviewer. A narrative synthesis was used to structure findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from included studies were synthesised to produce a conceptual framework. Results5715 publications were identified and 42 were included. Of these, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness and feeling ignored indicated D-QSC was not present. In ten applicable studies, a meta-an

Journal article

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2021, SWAY: Sleep disturbance as an early warning sign of suicidality in psychiatric inpatients transitioning to the community: an ecological momentary assessment study protocol

Working paper

Dewa L, Kalniunas A, Orleans-Foli S, Pappa S, Aylin Pet al., 2021, Detecting signs of deterioration in young patients with serious mental illness: a systematic review, Systematic Reviews, Vol: 10, Pages: 1-8, ISSN: 2046-4053

BackgroundSerious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14-25. Once diagnosed, young peoples’ health can deteriorate, and it is therefore vital to detect this early to prevent severe outcomes including hospitalisations and deaths by suicide. The main study aim is to describe and discuss observational studies that examine signs of deterioration in young patients with SMI. MethodsA systematic review guided by the published protocol was conducted. Cumulative Index to Nursing and allied Health Literature (CINAHL), MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC) and Web of Science were searched against pre-defined criteria until March 1st 2021. Observational studies were extracted according to design, country, participant, indicator, outcome and main finding categories. Quality was assessed independently using the Newcastle Ottawa Scale (NOS). ResultsOf the 15788 publications identified, 5 studies were included and subjected to narrative synthesis. Two indicators of mental health deterioration were identified: cognitive functioning (decline, worsening and poor school/academic performance) and expressed emotion status. Indicators revealed mixed views on predicting deterioration. Worsening cognitive functioning and expressed emotion status significantly predicted medication non-adherence and relapse respectively. However, a decline in cognitive functioning (poor academic performance) was not found to significantly correlate to deaths by suicide. Study quality was mostly poor and associations between indicators and varied outcomes were weak. The heterogeneous nature of the data made comparisons difficult and did not allow for further statistical analysis. ConclusionTo our knowledge, this is the first review of observational studies to identify indicators of deterioration in young patients with SMI. Worsening cognitive functioning and expressed emotion status could indicate non-adherence

Journal article

Cecil E, Dewa L, Ma R, Majeed F, Aylin Pet al., 2021, General practitioner and nurse practitioner attitudes towards electronic reminders in primary care: A qualitative analysis, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives Reminders in primary care administrative systems aim to help clinicians provide evidence-based care, prescribe safely and save money. However, increased use of reminders can lead to alert fatigue. Our study aimed to assess general practitioners’ (GPs) and nurse practitioners’ (NPs) views on electronic reminders in primary care.Design A qualitative analysis using semistructured interviews.Setting and participants Fifteen GPs and NP based in general practices located in North-West London and Yorkshire, England.Methods We collected data on participants’ views on: (1) perceptions of the value of information provided; (2) reminder-related behaviours and (3) how to improve reminders. We carried out a thematic analysis.Results Participants were familiar with reminders in their clinical systems and felt many were important to support their clinical work. However, participants reported, on average, 70% of reminders were ignored. Four major themes emerged: (1) reaction to a reminder, which was mixed and varied by situation. (2) Factors influencing the decision to act on reminders, often related to experience, consultation styles and interests of participants. Time constraints, alert design, inappropriate presentation and litigation were also factors. (3) Negative consequences of using reminders were increased workload or costs and compromising GP and NPs behaviour. (4) Factors relating to improving users’ engagement with reminders were prevention of unnecessary reminders through data linkage across healthcare administrative systems or the development of more intelligent algorithms. Participants felt training was vital to effectively manage reminders.Conclusions GPs and NPs believe reminders are useful in supporting the provision of good quality patient care. Improving GPs and NPs’ engagement with reminders centres on further developing their relevance to their clinical practice, which is personalised, considers cognitive workflow and s

Journal article

Dewa L, Lawrence-Jones A, Kalorkoti C, Jaques J, Pickles K, Lavelle M, Pappa S, Aylin Pet al., 2021, Reflections, impact and recommendations of a co-produced qualitative study with young people who have experience of mental health difficulties, Health Expectations, Vol: 24, Pages: 134-146, ISSN: 1369-6513

BackgroundThere is limited evidence of genuine equal partnership where power is shared with young people with mental health difficulties throughout all research stages, particularly in data collection and analysis.ObjectiveTo describe how our qualitative study, exploring young peoples’ perceptions on the feasibility of using technology to detect mental health deterioration, was co-produced using principles of co-production, whilst reflecting on impact, challenges and recommendations.MethodsYoung people with experience of mental health difficulties were appointed and then worked with researchers throughout all research stages. The study was evaluated against the five principles of co-production. Reflections from researchers and young people were collected throughout.ResultsSeven young people formed an initial Young People's Advisory Group (YPAG); three became co-researchers. Reflection was key throughout the process. Sharing power became easier and more evident as trust, confidence and mutual respect grew over time, particularly after a safe space was established. The safe space was crucial for open discussions, and our WhatsApp group enabled continual communication, support and shared decision-making. The resulting co-produced topic guide, coding framework, thematic map, papers and presentations demonstrated significant impact.ConclusionsTo our knowledge, this is the first qualitative mental health study to be co-produced using the principles of co-production. Our rigorous assessment can be utilized as an informative document to help others to produce meaningful co-produced future research. Although co-production takes time, it makes significant impact to the research, researchers and co-researchers. Flexible funding for spontaneous suggestions from co-researchers and more time for interview training is recommended.

Journal article

Watson R, Sellars E, Qualter P, Loades M, Shafran R, Pearce E, Pitman A, Geulayov G, Demokowicz O, Dewa L, Creswell Cet al., 2021, Brief: Evidence-informed recommendations for supporting young people with feeling lonely, isolated and disconnected, Brief: Evidence-informed recommendations for supporting young people with feeling lonely, isolated and disconnected

Report

Dewa L, Crandell C, Choong E, Jaques J, Bottle R, Kilkenny C, Lawrence-Jones A, Di Simplicio M, Nicholls D, Aylin Pet al., 2021, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown, Journal of Adolescent Health, ISSN: 1054-139X

PurposeExploring the impact of COVID-19 pandemic on young people’s mental health is an increasing priority. Studies to date are largely surveys and lack meaningful involvement from service users in their design, planning and delivery. The study aimed to examine the mental health status and coping strategies of young people during the first UK COVID-19 lockdown using co-production methodology.MethodsThe mental health status of young people (aged 16-24) in April 2020 was established utilising a sequential explanatory co-produced mixed methods design. Factors associated with poor mental health status including coping strategies were also examined using an online survey and semi-structured interviews.Results30.3% had poor mental health and 10.8% had self-harmed since lockdown. Young people identifying as Black/Black-British ethnicity had the highest increased odds of experiencing poor mental health (odds ratio [OR] 3.688, 95% CI 0.54-25.40). Behavioural disengagement (OR 1.462, 95% CI 1.22-1.76), self-blame (OR 1.307 95% CI 1.10-1.55), and substance use (OR 1.211 95% CI 1.02-1.44) coping strategies, negative affect (OR 1.109, 95% CI 1.07-1.15), sleep problems (OR 0.915 95% CI 0.88-0.95) and conscientiousness personality trait (OR 0.819 95% CI 0.69-0.98) were significantly associated with poor mental health. Three qualitative themes were identified: (1) pre-existing/developed helpful coping strategies employed, (2) mental health difficulties worsened and (3) mental health and non-mental health support needed during and after lockdown.ConclusionPoor mental health is associated with dysfunctional coping strategies. Innovative coping strategies can help other young people cope during and after lockdowns, with digital and school promotion and application.

Journal article

Aboaja A, Perry A, Steele R, Dewa L, Clarbour J, Cairney S, Carey Jet al., 2021, Sleep interventions for adults admitted to psychiatric inpatient settings: a scoping review protocol, The JBI Database of Systematic Reviews and Implementation Reports, ISSN: 1838-2142

Objective: The scoping review aims to identify how sleep is measured and what sleep interventions are used effectively in psychiatric inpatient settings. Potential barriers to measuring sleep in inpatient settings will be classified.Introduction: Polysomnography has shown that poor sleep is associated with emotional, cognitive, and somatic changes, as well as increased risks in suicide ideation and aggression. People with mental illness often experience sleep disturbances and believe the psychiatric inpatient environment contributes to sleep problems. The use of sleep interventions has been studied widely in general inpatient wards; less is known of similar interventions in psychiatric inpatient settings.Inclusion criteria: The review will include studies that have primarily studied the effectiveness of sleep interventions for adults in any psychiatric inpatient setting. Studies that focus solely on sleep apnea, parasomnias, or restless legs syndrome will be excluded.Methods: A literature search of PsycINFO, Web of Science, MEDLINE and Google Scholar will be conducted. Studies identified will be screened and examined against the eligibility criteria. Eligible studies will be assessed for risk of bias and relevant data extracted to answer the review questions. Extracted data will be presented in narrative and tabular formats.

Journal article

Dewa LH, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2020, Quality Social Connection as an 'Active Ingredient' in Digital Interventions for Young People With Depression and Anxiety: A Systematic Scoping Review and Meta-Analysis

Background: A quality social connection (QSC) can influence outcomes in mental health support. Digital interventions may modify this influence, although conceptualisation and evidence on psychiatric outcomes is limited. We aimed to conceptualise and appraise evidence on digital QSC (D-QSC) for young people. <br><br>Methods: Systematic scoping review and meta-analysis, with embedded stakeholder involvement, searching healthcare databases, websites and the grey literature. We included studies that explored QSC within a digital intervention as part of the prevention or treatment of depression and/or anxiety in 14-24-year olds. <br><br>Findings: 5714 publications were identified and 42 were included. Of these, there were 23,319 participants. D-QSC translated into a five-component conceptual framework: Rapport, Identity and commonality, Valued interpersonal dynamic, Engagement and Responded to and accepted (RIVER). There was a significant decrease in depression (-25.6%, 95% CI [-0.352, -0.160], p<0.0005) and anxiety (-15.1%, 95% CI [-0.251, -0.051], p<0.0005). Heterogeneity was high. Literature and stakeholder evidence showcased D-QSC’s importance in the prevention and treatment of depression, though evidence was weaker for anxiety. Stakeholder insights highlighted that demographic, dynamic and environmental factors, including blended care, may influence D-QSC experiences and outcomes. <br><br>Interpretation: D-QSC is an important and under-considered component for depression and anxiety outcomes. Whilst more research is required, the RIVER conceptual framework can inform standardised measures for D-QSC. These measures can be used in the development and evaluation of digital interventions for mental health, particularly during the COVID-19 pandemic, where necessary support will be increasingly provided in online spaces. <br><br>Funding: This work was funded by a Wellcome Trust Mental Health Priority Area 'Active

Working paper

Alford J, 2020, Being a mental health researcher seeing the impact you have makes it all worthwhile

Other

Archer S, Thibaut B, Dewa L, Ramtale S, D'Lima D, Simpson A, Murray K, Adam S, Darzi Aet al., 2020, Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study, Journal of Psychiatric and Mental Health Nursing, Vol: 27, Pages: 211-223, ISSN: 1351-0126

IntroductionBarriers and facilitators to incident reporting have been widely researched in general healthcare. However, it is unclear if the findings are applicable to mental healthcare where care is increasingly complex.AimTo investigate if barriers and facilitators affecting incident reporting in mental healthcare are consistent with factors identified in other healthcare settings.MethodData were collected from focus groups (n=8) with 52 members of staff from across [a large Mental Health] Trust and analysed with thematic analysis.ResultsFive themes were identified during the analysis. Three themes (i)learning and improvement, (ii)time, and (iii)fear were consistent with the existing wider literature on barriers and facilitators to incident reporting. Two further themes (iv)interaction between patient diagnosis and incidents and (v)aftermath of an incident – prosecution specifically linked to the provision of mental healthcare.ConclusionsWhilst some barriers and facilitators to incident reporting identified in other settings are also prevalent in the mental healthcare setting, the increased incidence of violent and aggressive behaviour within mental healthcare presents a unique challenge for incident reporting.Clinical ImplicationsAlthough Interventions to improve incident reporting may be adapted/adopted from other settings, there is a need to develop specific interventions to improve reporting of violent and aggressive incidents.

Journal article

Dewa L, Thibaut B, Pattison N, User Voice, Aylin P, Archer S, Sheaves Bet al., 2020, Treating insomnia in prisoners: a feasibility study of a multi-component treatment pathway, Publisher: Journal of Sleep Research

Working paper

Thibaut B, Dewa L, Ramtale S, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer Set al., 2019, Patient safety in inpatient mental health settings: a systematic review, BMJ Open, Vol: 9, Pages: 1-19, ISSN: 2044-6055

Objectives: Patients in inpatient mental health settings face similar risks to those in other areas of health care (e.g. medication errors). In addition, some unsafe behaviours associated with serious mental health problems (e.g. self-harm), and the measures taken to address these (e.g. restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design: Systematic review and meta-synthesis. Embase, CINAHL, HMIC, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to “mental health”, “patient safety”, “inpatient setting” and “research”. Study quality was assessed using the Hawker checklist. Data was extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random effects model.Results: Of the 57,637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150,000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions: Patient safety in inpatient mental health settings is under researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety which require investment in research, policy development, and translation into clinical practice.

Journal article

Dewa L, Lavelle M, Pickles K, Jaques J, Kalorkoti C, Pappa S, Aylin Pet al., 2019, Young adults’ perceptions of using wearables, social media and other technologies to detect worsening mental health: a qualitative study, PLoS One, Vol: 14, 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

Cecil EV, Dewa L, Ma R, Majeed A, Aylin Pet al., 2019, Primary health care professionals views of reminders in electronic patient records, JECH, Publisher: BMJ PUBLISHING GROUP, Pages: A64-A64, ISSN: 0143-005X

Conference paper

Aboaja A, Carey J, Dewa L, 2019, Forensic Aspects of Sleep, 11th European Congress on Violence in Clinical Psychiatry, ISSN: 8270-9629

Conference paper

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, 1.01.7.66), 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

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