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Punjabi N, Marszalek K, Beaney T, et al., 2021, Categorising high-cost high-need children and young people, Archives of Disease in Childhood, Vol: 107, Pages: 346-350, ISSN: 0003-9888
Objectives To describe the characteristics of high-cost high-need children and young people (CYP) (0–24 years) in England.Methods Retrospective observational study using data from the Clinical Practice Research Database linked to Hospital Episode Statistics in 2014/2015 and 2015/2016. Healthcare utilisation of primary and secondary care services were calculated, and costs were estimated using Healthcare Resource Group for secondary care and Personal Social Services Research Unit for primary care. High-cost high-need CYP were defined as the top 5% of users by cost.Results 3891 of 73 392 CYP made up the top 5% that were classified as high-cost high-need, and this group accounted for 54% of total annual costs. In this population, 7.3% were males <5 years and 11.0% were females 20–24 years. Inpatient care (acute) accounted for 63% of known spending in high-cost high-need patients. Total mean monthly cost per patient was 22.7 times greater in the high-cost high-need group compared with all other patients (£4417 vs £195). 29% of CYP in the high-cost high-need group in 2014/2015 were also classified as high-cost high-need in the following year.Conclusions These findings indicate the importance of further understanding and anticipating trends in CYP health spending to optimise care, reduce costs and inform new models of care. This includes integrated services, a further look into societal factors in reducing health inequalities and a particular focus of mental health services, the demand of which increases with age.
Leslie M, Halls D, Leppanen J, et al., 2021, The neural correlates of a central coherence task in young women with anorexia nervosa, European Eating Disorders Review, Vol: 29, Pages: 744-755, ISSN: 1072-4133
ObjectiveHeightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples.MethodsWe recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan.ResultsThere were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task.ConclusionsThese findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.
Burmester V, Nicholls D, Buckle A, et al., 2021, Review of eating disorders and oxytocin receptor polymorphisms., Journal of Eating Disorders, Vol: 9, Pages: 1-9, ISSN: 2050-2974
BACKGROUND AND AIMS: Oxytocin, a nine amino acid peptide synthesised in the hypothalamus, has been widely recognised for its role in anxiolysis, bonding, sociality, and appetite. It binds to the oxytocin receptor (OXTR)-a G-protein coupled receptor-that is stimulated by the actions of oestrogen both peripherally and centrally. Studies have implicated OXTR genotypes in conferring either a risk or protective effect in autism, schizophrenia, and eating disorders (ED). There are numerous DNA variations of this receptor, with the most common DNA variation being in the form of the single nucleotide polymorphisms (SNPs). Two OXTR SNPs have been most studied in relation to ED: rs53576 and rs2254298. Each SNP has the same allelic variant that produces genotypes AA, AG, and GG. In this critical review we will evaluate the putative role of rs53576 and rs2254298 SNPs in ED. Additionally, this narrative review will consider the role of gene-environment interactions in the development of ED pathology. FINDINGS: The OXTR SNPs rs53576 and rs2254298 show independent associations between the A allele and restrictive eating behaviours. Conversely, the G allele of the OXTR rs53576 SNP is associated with binging behaviours, findings that were also evident in neuroanatomy. One study found the A allele of both OXTR SNPs to confer risk for more severe ED symptomatology while the G allele conferred some protective effect. An interaction between poor maternal care and rs2254298 AG/AA genotype conferred increased risk for binge eating and purging in women. CONCLUSIONS: Individual OXTR SNP are unlikely in themselves to explain complex eating disorders but may affect the expression of and/or effectiveness of the OXTR. A growing body of G x E work is indicating that rs53576G homozygosity becomes disadvantageous for later mental health under early adverse conditions but further research to extend these findings to eating pathology is needed. The GWAS approach would benefit this area of knowledge.
Pascual-Sanchez A, Hickey N, Mateu A, et al., 2021, Personality traits and self-esteem in traditional bullying and cyberbullying, PERSONALITY AND INDIVIDUAL DIFFERENCES, Vol: 177, ISSN: 0191-8869
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- Citations: 9
Halls D, Leslie M, Leppanen J, et al., 2021, The emotional face of anorexia nervosa: The neural correlates of emotional processing, HUMAN BRAIN MAPPING, Vol: 42, Pages: 3077-3087, ISSN: 1065-9471
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- Citations: 5
Byford S, Petkova H, Barrett B, et al., 2021, Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study, JOURNAL OF EATING DISORDERS, Vol: 9, ISSN: 2050-2974
Nicholson J, Nicholls D, 2021, Clinical and diagnostic characteristics of eating disorders in children and adolescents, Understanding Eating Disorders: Integrating Culture, Psychology and Biology, Pages: 43-57, ISBN: 9781617282980
Solmi F, Downs JL, Nicholls DE, 2021, COVID-19 and eating disorders in young people, LANCET CHILD & ADOLESCENT HEALTH, Vol: 5, Pages: 316-318, ISSN: 2352-4642
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- Citations: 47
Rosello R, Gledhill J, Yi I, et al., 2021, Early intervention in child and adolescent eating disorders: The role of a parenting group, EUROPEAN EATING DISORDERS REVIEW, Vol: 29, Pages: 519-526, ISSN: 1072-4133
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- Citations: 11
Osmanov IM, Spiridonova E, Bobkova P, et al., 2021, Risk factors for long covid in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study
<jats:p>Background The long-term sequelae of coronavirus disease 2019 (Covid-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with Covid-19 and associated risk factors.Methods This is a prospective cohort study of children (18 years old and younger) admitted with confirmed Covid-19 to Z.A. Bashlyaeva Children's Municipal Clinical Hospital in Moscow, Russia. Children admitted to the hospital during the first wave of the pandemic, between April 2, 2020 and August 26, 2020, were included. Telephone interview using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Covid-19 Health and Wellbeing paediatric follow up survey. Persistent symptoms (>5 months) were further categorised by system(s) involved. Findings Overall, 518 of 853 (61%) of eligible children were available for the follow-up assessment and included in the study. Median age was 10.4 years (IQR, 3-15.2) and 270 (52.1%) were girls; median follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%,) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: age "6-11 years" (odds ratio 2.74 (95% confidence interval 1.37 to 5.75) and "12-18 years" (2.68, 1.41 to 5.4), and a history of allergic diseases (1.67, 1.04 to 2.67).Interpretation A quarter of children experienced persistent symptoms months after hospitalization with acute covid-19 infection, with almost one in ten experiencing multi-system involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up. Our findings highlight the need for replication and further investigation of potential mechanisms as well as c
Burmester V, Graham E, Nicholls D, 2021, Physiological, emotional and neural responses to visual stimuli in eating disorders: a review, Journal of Eating Disorders, Vol: 9, ISSN: 2050-2974
BACKGROUND: Overconcern with food and shape/weight stimuli are central to eating disorder maintenance with attentional biases seen towards these images not present in healthy controls. These stimuli trigger changes in the physiological, emotional, and neural responses in people with eating disorders, and are regularly used in research and clinical practice. However, selection of stimuli for these treatments is frequently based on self-reported emotional ratings alone, and whether self-reports reflect objective responses is unknown. MAIN BODY: This review assessed the associations across emotional self-report, physiological, and neural responses to both food and body-shape/weight stimuli in people with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). For food stimuli, either an aversive or lack of physiological effect was generated in people with AN, together with a negative emotional response on neuroimaging, and high subjective anxiety ratings. People with BN showed a positive self-rating, an aversive physiological reaction, and a motivational neural response. In BED, an aversive physiological reaction was found in contrast to motivational/appetitive neural responses, with food images rated as pleasant. The results for shape/weight stimuli showed aversive responses in some physiological modalities, which was reflected in both the emotional and neural responses, but this aversive response was not consistent across physiological studies. CONCLUSIONS: Shape/weight stimuli are more reliable for use in therapy or research than food stimuli as the impact of these images is more consistent across subjective and objective responses. Care should be taken when using food stimuli due to the disconnect reported in this review.
Horby PW, Roddick A, Spata E, et al., 2021, Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial, The Lancet, Vol: 397, Pages: 605-612, ISSN: 0140-6736
BackgroundAzithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.MethodsIn this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.FindingsBetween April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No
Viner R, Russell S, Saulle R, et al., 2021, Impacts of school closures on physical and mental health of children and young people: a systematic review
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The well-documented links between education and health mean that school closures during the COVID-19 pandemic are likely to be associated with significant health harms to children and young people (CYP). A systematic review of the evidence is needed to inform policy decisions around school closures and re-openings during the pandemic.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We undertook a high-quality systematic review of observational quantitative studies (published or preprint) of the impacts of school closures (for any reason) on the health, wellbeing and educational outcomes of CYP, excluding impacts of closure on transmission of infection (PROSPERO CRD42020181658). We used a machine learning approach for screening articles, with decisions on inclusion and data extraction performed independently by 2 researchers. Quality was assessed for study type. A narrative synthesis of results was undertaken as data did not allow meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>16,817 records were screened, of which 151 were reviewed in full-text and 72 studies were included from 20 countries. 33% were cohort studies using historical control periods; 19% pre-post studies; and 46% cross-sectional studies which assessed change by comparison with population reference data. 63% were high-quality, 25% medium-quality and 13% low-quality. Cause of closure in all studies was the first COVID-19 pandemic wave with the exception of 5 influenza studies and 1 teacher strike.</jats:p><jats:p>27 studies concerning mental health identified considerable impacts across emotional, behavioural and restlessness/inattention problems; 18-60% of CYP scored above risk thresholds for distress, particularly anxiety and depressive sympt
Lock J, Le Grange D, Nicholls D, et al., 2021, Editorial: innovations in research and practice of family based treatment for eating disorders, Frontiers in Psychiatry, Vol: 11, Pages: 1-2, ISSN: 1664-0640
Dewa L, Crandell C, Choong E, et 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.
Viner R, Russell S, Saulle R, et al., 2021, Associations of School Closures with and without Social Lockdown on Physical and Mental Health of Children and Young People during the First COVID-19 Wave: A Systematic Review, JAMA Pediatrics, ISSN: 2168-6203
Importance: School closures during COVID-19 are likely to be associated with significant health harms to children and young people. A systematic review of the evidence is needed to inform policy decisions around school closures and reopenings. Objective: To assess the associations of school closures on health and well-being outcomes in children and young people aged 0 to 19 years, excluding associations with transmission of infection. Evidence Review: Eleven databases were searched from inception to September 2020, and machine learning was applied for screening articles. A total of 16817 records were screened, 151 were reviewed in full text, and 43 studies were included. Quality assessment was tailored to study type. A narrative synthesis of results was undertaken because data did not allow meta-analysis. Findings: A total of 43 studies from 12 countries with 104630 study individuals were included in analysis. Of those, 9 (21%) were longitudinal pre-post studies, 5 (12%) were cohort, 28 (65%) were cross-sectional, and 1 (1%) was a modeling study; all assessed change by comparison with population reference data. Eighteen studies (42%) were high quality, 19 (45%) were medium quality, and 6 (14%) were low quality. Cause of closure in all studies was the first COVID-19 wave with the exception of 5 influenza studies (11.6%). Twenty-seven studies (62.8%) concerning mental health identified considerable associations across emotional, behavioral, and restlessness/inattention problems; 18% to 60% of children and young people scored above risk thresholds for distress, particularly anxiety and depressive symptoms. Two studies reported nonsignificant rises in suicide. Child protection referrals fell 27% to 39% to half the expected number of referrals originating in schools. Data suggested marked rises in screen time and social media use and reductions in physical activity; however, data on sleep and diet were inconclusive. Available data suggested likely higher harms in childre
Leslie M, Halls D, Leppanen J, et al., 2020, Corrigendum: Neural correlates of theory of mind are preserved in young women with anorexia nervosa, Frontiers in Psychology, Vol: 11, Pages: 1-2, ISSN: 1664-1078
Burmester V, Nicholls D, 2020, Effect of the COVID-19 quarantine on emotional eating in youth, Eating Disorders Research Society (EDRS 2020)
Dewa L, Crandell C, Choong E, et al., 2020, CCopeY: a mixed-methods co-produced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown
Leslie M, Halls D, Leppanen J, et al., 2020, Neural correlates of theory of mind are preserved in young women with anorexia nervosa, Frontiers in Psychology, Vol: 11, Pages: 1-8, ISSN: 1664-1078
People with anorexia nervosa (AN)commonly exhibit social difficulties, which may be related to problems with understanding the perspectives of others, commonly known as Theory of Mind (ToM) processing. However, there is a dearth of literature investigating the neural basis of these differences in ToM and at what age they emerge.This study aimed to test for differences in the neural correlates of ToM processes in young women with AN, and young women weight-restored from AN, as compared to healthy control participants(HC). Based on previous findings in AN, we hypothesised that young women with current or prior AN, as compared to HCs,would exhibit a reduced neural response in the medial prefrontal cortex, the inferior frontal gyrus, and the temporo-parietal junction whilst completing a ToMtask.We recruited 73 young women with AN, 45 weight-restored young women, and 70 young women without a history of AN to take part in the current study. Whilst undergoing a functional magnetic resonance imaging(fMRI)scan, participants completed the Frith-Happé task, which is a commonly-used measure of ToM with demonstrated reliability and validity in adult populations. In this task, participantsviewed the movements of triangles, which depicted either action movements, simple interactions, or complex social interactions.Viewing trials with more complex social interactions in the Frith-Happé task was associated with increased brain activation in regions including the right temporo-parietal junction, the bilateral medial prefrontal cortex, the cerebellum, and the dorsolateral prefrontal cortex. There were no group differences in neural activation in response to the ToM contrast. Overall, these results suggest that the neural basis of spontaneous mentalising is preserved in most young women with AN.
Mateu A, Martinez-Herves M, Nicholls D, et al., 2020, Cyberbullying and post-traumatic stress symptoms in UK adolescents, Archives of Disease in Childhood, ISSN: 0003-9888
Alberts Z, Fewtrell M, Nicholls DE, et al., 2020, Bone mineral density in Anorexia Nervosa versus Avoidant Restrictive Food Intake Disorder, BONE, Vol: 134, ISSN: 8756-3282
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- Citations: 12
Nicholls D, Becker A, 2020, Food for thought: bringing eating disorders out of the shadows, British Journal of Psychiatry, Vol: 216, Pages: 67-68, ISSN: 0007-1250
Eating disorders are prevalent, potentially lethal, and treatable and yet remainunderprioritised within clinical care, research, and policy. Further, with rising public healthfocus on obesity, there is heightened risk for inadvertent exacerbation of disordered eatingand further marginalisation of these serious mental disorders. This editorial calls forcorrective action.
Neale J, Pais SMA, Nicholls D, et al., 2020, What Are the Effects of Restrictive Eating Disorders on Growth and Puberty and Are Effects Permanent? A Systematic Review and Meta-Analysis, JOURNAL OF ADOLESCENT HEALTH, Vol: 66, Pages: 144-156, ISSN: 1054-139X
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- Citations: 17
Lock J, Nicholls D, 2020, Toward a greater understanding of the ways family-based treatment addresses the full range of psychopathology of adolescent anorexia nervosa, Frontiers in Psychiatry, Vol: 10, Pages: 1-8, ISSN: 1664-0640
Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT.
Viner RM, Kinra S, Christie D, et al., 2020, Improving the assessment and management of obesity in UK children and adolescents: The PROMISE research programme including a RCT, Programme Grants for Applied Research, Vol: 8, Pages: vii-237, ISSN: 2050-4322
Background: Five linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway. Objectives: (1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E). Methods: Five substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre. Results: Study A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primar
Ghaznavi I, Gillies D, Nicholls D, et al., 2020, Photorealistic avatars to enhance the efficacy of Self-attachment psychotherapy, 3rd IEEE International Conference on Artificial Intelligence and Virtual Reality (IEEE AIVR), Publisher: IEEE COMPUTER SOC, Pages: 60-67
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- Citations: 1
Petkova H, Simic M, Nicholls D, et al., 2019, Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study, BMJ Open, Vol: 9, Pages: 1-9, ISSN: 2044-6055
Objectives This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.Design Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.Setting The study was based in the UK and Ireland.Participants Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.Main outcome measures Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.Results 305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.Conclusion These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.
Viner R, Ward J, Hudson L, et al., 2019, Roles of cyberbullying, sleep and physical activity in mediating the impact of social media use on mental health and wellbeing: findings from a national cohort of English young people, The Lancet Child and Adolescent Health, Vol: 3, Pages: 685-696, ISSN: 2352-4642
BackgroundThere is growing concern about the potential associations between social media use and mental health and wellbeing in young people. We explored associations between the frequency of social media use and later mental health and wellbeing in adolescents, and how these effects might be mediated.MethodsWe did secondary analyses of publicly available data from the Our Futures study, a nationally representative, longitudinal study of 12 866 young people from age 13 years to 16 years in England. The exposure considered was the frequency of social media use (from weekly or less to very frequent [multiple times daily]) at wave 1 (participants aged 13–14 years) through wave 3 of the study (participants aged 15–16 years). Outcomes were mental health at wave 2 (with high 12-item General Health Questionnaire [GHQ12] scores [≥3] indicating psychological distress), and wellbeing at wave 3 (life satisfaction, feeling life is worthwhile, happiness, and anxiety, rated from 1 to 10 by participants). Analyses were adjusted for a minimal sufficient confounding structure, and were done separately for boys and girls. Cyberbullying, sleep adequacy, and physical activity were assessed as potential mediators of the effects.FindingsVery frequent use of social media increased from wave 1 to wave 3: from 34·4% (95% CI 32·4–36·4) to 61·9% (60·3–63·6) in boys, and 51·4% (49·5–53·3) to 75·4% (73·8–76·9) in girls. Very frequent social media use in wave 1 predicted a high GHQ12 score at wave 2 among girls (adjusted odds ratio [OR] 1·31 [95% CI 1·06–1·63], p=0·014; N=4429) and boys (1·67 [1·24–2·26], p=0·0009; N=4379). Persistent very frequent social media use across waves 1 and 2 predicted lower wellbeing among girls only (adjusted ORs 0·86 [0·74–0·99], N=3753, p=0·039
Viner RM, Aswothikutty-Gireesh A, Stiglic N, et al., 2019, Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data, LANCET CHILD & ADOLESCENT HEALTH, Vol: 3, Pages: 685-696, ISSN: 2352-4642
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- Citations: 113
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