Imperial College London

ProfessorPaulRamchandani

Faculty of MedicineDepartment of Medicine

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 3313 4161p.ramchandani

 
 
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Assistant

 

Ms Nicole Hickey +44 (0)20 3313 4161

 
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Location

 

Commonwealth BuildingHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

139 results found

Murphy SE, Braithwaite EC, Hubbard I, Williams KV, Tindall E, Holmes EA, Ramchandani PGet al., 2019, Salivary cortisol response to infant distress in pregnant women with depressive symptoms (vol 18, pg 247, 2015), ARCHIVES OF WOMENS MENTAL HEALTH, Vol: 22, Pages: 313-313, ISSN: 1434-1816

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Gutierrez-Galve L, Stein A, Hanington L, Heron J, Lewis G, O'Farrelly C, Ramchandani PGet al., 2019, Association of Maternal and Paternal Depression in the Postnatal Period With Offspring Depression at Age 18 Years, JAMA PSYCHIATRY, Vol: 76, Pages: 290-296, ISSN: 2168-622X

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Domoney J, Fulton E, Stanley N, McIntyre A, Heslin M, Byford S, Bick D, Ramchandani P, MacMillan H, Howard LM, Trevillion Ket al., 2019, For Baby’s Sake: Intervention Development and Evaluation Design of a Whole-Family Perinatal Intervention to Break the Cycle of Domestic Abuse, Journal of Family Violence, ISSN: 0885-7482

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. For Baby’s Sake is an innovative whole-family intervention that works with parents from pregnancy to two years postpartum to break cycles of domestic abuse and improve outcomes for children. The programme launched in 2015 across two community settings in England, with an independent evaluation led by King’s College London. This paper aims to (1) summarise the process of developing For Baby’s Sake and how it has been embedded within two different settings and (2) describe the evaluation design using early data to illustrate successes and challenges. The programme was developed following a review of the evidence and extensive stakeholder engagement. Three experts co-designed the content in partnership with the Stefanou Foundation and the programme delivery teams have been integrated into two local authorities. The evaluation uses mixed methods to assess abuse victimisation/perpetration, mental health, parenting and child outcomes, alongside service user experiences of early engagement. Forty individuals (27 women and 13 men) have been recruited to the evaluation. Early findings suggest that parents value the novel approach of For Baby’s Sake and their relationships with practitioners. Data on parents’ mental health and childhood adversities supports the decision to create a trauma-informed intervention. Interventions for domestic abuse are necessary to improve health and behaviour outcomes for families and prevent intergenerational transmission of abuse and developmental trauma. For Baby’s Sake addresses limitations of existing interventions, through its trauma-informed, attachment-based, whole-family approach. Early data from the evaluation suggests that the programme is reaching its intended audience and that service users appreciate the supportive approach.

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Lambregtse-van den Berg MP, Tiemeier H, Verhulst FC, Jaddoe V, Tindall E, Vlachos H, Aumayer K, Iles J, Ramchandani PGet al., 2018, Early childhood aggressive behaviour: Negative interactions with paternal antisocial behaviour and maternal postpartum depressive symptoms across two international cohorts, EUROPEAN PSYCHIATRY, Vol: 54, Pages: 77-84, ISSN: 0924-9338

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Fernandes M, Srinivasan K, Menezes G, Ramchandani PGet al., 2018, Prenatal depression, fetal neurobehavior, and infant temperament: Novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort, DEVELOPMENT AND PSYCHOPATHOLOGY, Vol: 30, Pages: 725-742, ISSN: 0954-5794

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Asarnow J, Bloch MH, Brandeis D, Burt SA, Fearon P, Fombonne E, Green J, Gregory A, Gunnar M, Halperin JM, Hollis C, Jaffee S, Klump K, Landau S, Lesch K-P, Oldehinkel AJT, Peterson B, Ramchandani P, Sonuga-Barke E, Stringaris A, Zeanah CHet al., 2018, Special Editorial: Open science and the Journal of Child Psychology & Psychiatry - next steps?, JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY, Vol: 59, Pages: 826-827, ISSN: 0021-9630

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Fear N, Reed R, Rowe S, Burdett H, Pernet D, Mahar A, Iverson A, Ramchandani P, Stein A, Wessely Set al., 2018, Impact of paternal deployment to the conflicts in Iraq and Afghanistan and paternal post-traumatic stress disorder on the children of military fathers, British Journal of Psychiatry, Vol: 212, Pages: 347-355, ISSN: 0007-1250

BackgroundLittle is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.MethodFathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.ResultsIn total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.ConclusionsThis study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.

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Sethna V, Murray L, Edmondson O, Iles J, Ramchandani PGet al., 2018, Depression and playfulness in fathers and young infants: A matched design comparison study, JOURNAL OF AFFECTIVE DISORDERS, Vol: 229, Pages: 364-370, ISSN: 0165-0327

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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MGet al., 2018, The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science, LANCET PSYCHIATRY, Vol: 5, Pages: 237-286, ISSN: 2215-0374

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Ramchandani P, 2017, ECAP Editorial, European Child and Adolescent Psychiatry, Vol: 26, Pages: 1407-1408, ISSN: 1018-8827

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Ramchandani P, O'Farrelly C, Babelis D, Bakermans-Kranenburg M, Byford S, Grimas E, Iles J, van IJzendoorn M, McGinley J, Phillips C, Stein A, Warwick J, Watt H, Scott Set al., 2017, Preventing enduring behavioural problems in young children through early psychological intervention (Healthy Start, Happy Start): study protocol for a randomized controlled trial, Trials, Vol: 18, ISSN: 1745-6215

Background: Behavioural problems are common in early childhood, and can result in enduring costs to the individualand society, including an increased risk of mental and physical illness, criminality, educational failure and drug andalcohol misuse. Most previous research has examined the impact of interventions targeting older children whendifficulties are more established and harder to change, and have rarely included fathers. We are conducting a trial of apsychological intervention delivered to families with very young children, engaging both parents where possible.Methods: This study is a two-arm, parallel group, researcher-blind, randomized controlled trial, to test the clinicaleffectiveness and cost-effectiveness of a parenting intervention, Video Feedback Intervention to Promote PositiveParenting and Sensitive Discipline (VIPP-SD) for parents of young children (12–36 months) at risk of behaviouraldifficulties. VIPP-SD is an evidence-based parenting intervention developed at Leiden University in the Netherlandswhich uses a video-feedback approach to support parents, particularly by enhancing parental sensitivity and sensitivediscipline in caring for children.The trial will involve 300 families, who will be randomly allocated into either an intervention group, who will receivethe video-feedback intervention (n = 150), or a control group, who will receive treatment as usual (n = 150). The trialwill evaluate whether VIPP-SD, compared to treatment as usual, leads to lower levels of behavioural problems in youngchildren who are at high risk of developing these difficulties. Assessments will be conducted at baseline, and 5 and24 months post-randomization. The primary outcome measure is a modified version of the Preschool Parental Accountof Child Symptoms (Pre-PACS), a structured clinical interview of behavioural symptoms. Secondary outcomes includecaregiver-reported behavioural difficulties, parenting behaviours, parental sensitivity, parental mood and anxiety a

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Capron L, Ramchandani P, Glover V, 2017, Maternal prenatal stress and placental gene expression of NR3C1 and HSD11B2; the effects of maternal ethnicity, Psychoneuroendocrinology, Vol: 87, Pages: 166-172, ISSN: 0306-4530

BackgroundPrenatal stress is associated with altered fetal and infant development. Previous studies have suggested that these effects may be mediated in part via altered functioning of placental enzymes and receptors involved in the HPA-axis, including the glucocorticoid receptor (NR3C1) and HSD11B2, the enzyme which metabolises cortisol. However, previous studies have not examined the potential ethnicity effects on these associations. This study aimed to characterise the association between maternal prenatal stress and placental genes expression and subsequently, any potential effect of maternal ethnicity.MethodPregnant women(n = 83) were recruited prior to elective caesarean section and assessed for trait anxiety, depression and life events. Placentas were collected and placental gene expression of NR3C1 and HSD11B2 were analysed. We examined associations between maternal prenatal stress and placental gene expression, and the tested for a possible moderating effect of maternal ethnicity(59.0% Caucasian;41.0% non-Caucasian:12.0% South Asian;6.0% African/African-American;14.4% Other;8.4% Mixed).ResultsAnalyses demonstrated a trend in the association between both maternal trait anxiety and depression symptoms with placental gene expression of NR3C1(adj.β = .220,p = .067;adj.β = .212,p = .064 respectively). We found a significant interaction with maternal ethnicity(β = .249;p = .033). In Caucasian women only prenatal trait anxiety and depressive symptoms were associated with an increase in placental NR3C1 expression(adj.β = .389,p = .010;adj.β = .294;p = .047 respectively). Prenatal life events were associated with a down regulation of HSD11B2(adj.β = .381;p = .008), but only in Caucasians.ConclusionThese results support previous findings of an association between maternal prenatal stress and the expression of placental genes associated with the HPA-axis, but only in Caucasians. These ethnic specific findings are novel and require replica

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Crawford MJ, Gold C, Odell-Miller H, Thana L, Faber S, Assmus J, Bieleninik L, Geretsegger M, Grant C, Maratos A, Sandford S, Claringbold A, McConachie H, Maskey M, Mossler KA, Ramchandani P, Hassiotis Aet al., 2017, International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study, HEALTH TECHNOLOGY ASSESSMENT, Vol: 21, Pages: 1-+, ISSN: 1366-5278

Background:Preliminary studies have indicated that music therapy may benefit children with autismspectrum disorders (ASD).Objectives:To examine the effects of improvisational music therapy (IMT) on social affect andresponsiveness of children with ASD.Design:International, multicentre, three-arm, single-masked randomised controlled trial, including aNational Institute for Health Research (NIHR)-funded centre that recruited in London and the east ofEngland. Randomisation was via a remote service using permuted blocks, stratified by study site.Setting:Schools and private, voluntary and state-funded health-care services.Participants:Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent orguardian who provided written informed consent. We excluded children with serious sensory disorder andthose who had received music therapy within the past 12 months.Interventions:All parents and children received enhanced standard care (ESC), which involved three60-minute sessions of advice and support in addition to treatment as usual. In addition, they wererandomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESCalone, over 5 months in a ratio of 1 : 1 : 2.Main outcome measures:The primary outcome was measured using the social affect score derived fromthe Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment.Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and12 months (higher scores indicated greater impairment).Results:A total of 364 participants were randomised between 2011 and 2015. A total of 182 children wereallocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocatedto ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) inthe intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171(94.0

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Braithwaite EC, Murphy SE, Ramchandani PG, Hill Jet al., 2017, Associations between biological markers of prenatal stress and infant negative emotionality are specific to sex., Psychoneuroendocrinology, Vol: 86, Pages: 1-7, ISSN: 0306-4530

PURPOSE: Fetal programming is the idea that environmental stimuli can alter the development of the fetus, which may have a long-term effect on the child. We have recently reported that maternal prenatal cortisol predicts infant negative emotionality in a sex-dependent manner: high prenatal cortisol was associated with increased negative emotionality in females, and decreased negative emotionality in males. This study aims to test for this sex-specific effect in a different cohort, and investigate whether sex differences in fetal programming may be specific to glucocorticoid mechanisms by also examining a maternal salivary alpha-amylase (sAA) by sex interaction. METHODS: 88 pregnant women (mean gestational age=27.4 weeks, SD=7.4) collected saliva samples at home over two working days to be assayed for the hormone cortisol (range=0.13-88.22nmol/l) and the enzyme alpha-amylase (range=4.57-554.8units/ml). Samples were collected at waking, 30-min post-waking and 12h post-waking. Two months after birth participants reported infant negative emotionality using the distress to limits subscale of the Infant Behavior Questionnaire. RESULTS: The interaction between maternal prenatal cortisol and infant sex to predict distress to limits approached significance (p=0.067). In line with our previous finding there was a positive association between prenatal cortisol and negative emotionality in females, and a negative association in males. The interaction between sAA and sex to predict distress was significant (p=0.025), and the direction of effect was the same as for the cortisol data; high sAA associated with increased negative emotionality in females and reduced negative emotionality in males. CONCLUSIONS: In line with our previous findings, this research adds to an emerging body of literature, which suggests that fetal programming mechanisms may be sex-dependent. This is the first study to demonstrate that maternal prenatal sAA may be an important biomarker for infant behavior

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Domoney J, Iles J, Ramchandani P, 2017, Fathers in the perinatal period: Taking their mental health into account, Transforming Infant Wellbeing: Research, Policy and Practice for the First 1001 Critical Days, Pages: 205-214, ISBN: 9781138689534

BOOK CHAPTER

Day C, Briskman J, Crawford MJ, Harris L, McCrone P, McMurran M, Moran P, Morgan L, Scott S, Stahl D, Ramchandani P, Weaver Tet al., 2017, Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme, Contemporary Clinical Trials Communications, Vol: 8, Pages: 67-74, ISSN: 2451-8654

The Helping Families Programme is a psychoeducational parenting intervention that aims to improve outcomes and engagement for parents affected by clinically significant personality difficulties. This is achieved by working collaboratively with parents to explore ways in which their emotional and relational difficulties impact on parenting and child functioning, and to identify meaningful and realistic goals for change. The intervention is delivered via one-to-one sessions at weekly intervals over a period of 16 weeks. This protocol describes a two-arm parallel RCT in which consenting parents are randomly allocated in a 1:1 ratio to either the Helping Families Programme plus the usual services that the parent may be receiving from their mental health and/or social care providers, or to standard care (usual services plus a brief parenting advice session). The primary clinical outcome will be child behaviour. Secondary clinical outcomes will be child and parental mental health, parenting satisfaction, parenting behaviour and therapeutic alliance. Health economic measures will be collected on quality of life and service use. Outcome measures will be collected at the initial assessment stage, after the intervention is completed and at 6-month follow-up by research staff blind to group allocation. Trial feasibility will be assessed using rates of trial participation at the three time points and intervention uptake, attendance and retention. A parallel process evaluation will use qualitative interviews to ascertain key-workers’ and parent participants' experiences of intervention delivery and trial participation. The results of this feasibility study will determine the appropriateness of proceeding to a full-scale trial.

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Ryan R, O'Farrelly C, Ramchandani P, 2017, Parenting and child mental health., London Journal of Primary Care, Vol: 9, Pages: 86-94, ISSN: 1757-1472

This paper reviews parenting programmes and their effectiveness with families of young children and highlights additional resources for primary care practitioners. Typically, 30% of GP consultations concern child behaviour problems and established behaviour problems can have lasting effects on children's life chances. These problems can be identified in infancy and toddlerhood.Parenting is a key risk factor in their development and maintenance, yet is also amenable to change. In this paper we consider six parenting programmes that are widely evaluated and/or available in the U.K. and their evidence base . These include two NICE recommended parenting programmes (Incredible Years and Triple P), which offer tiered and flexible parenting programmes; predominantly for parents of school-age children. We also review Parent-Infant Psychotherapy, which is typically for parents of younger children. Fourth is Family Nurse Partnership, an intensive programme to support young, first-time mothers. Finally we consider, video feedback programmes which use video to focus in detail on parents' interactions with their children, including Video Feedback to Promote Positive Parenting and Video Interactive Guidance. These interventions demonstrate the range of approaches which are being used to intervene early in children's lives to try to prevent the development of enduring behavioural problems. Why this matters to me: It is becoming increasingly clear that the origins of many mental health problems lie in childhood. Family factors, including the quality of care that parents provide for their children, can make a huge difference to children's early life pathways, for better or for worse. Understanding how best to intervene to support parents is a key challenge. In this article, we critically review the most widely used parenting programmes for parents of young children. It is imperative that we judge these early interventions to high standards so

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Marcano Belisario JS, Doherty K, O'Donoghue J, Ramchandani P, Majeed A, Doherty G, Morrison C, Car Jet al., 2017, A bespoke mobile application for the longitudinal assessment of depression and mood during pregnancy: protocol of a feasibility study, BMJ Open, Vol: 7, ISSN: 2044-6055

Introduciton: Depression is a common mental health disorders during pregnancy, with important consequences for mothers and their children. Despite this, it goes undiagnosed and untreated in many women attending antenatal care. Smartphones could help support the prompt dentification of antenatal depression in this setting. In addition, these devices enable the implementation of ecological momentary assessment techniques, which could be used to assess how mood is experienced during pregnancy. With this study, we will assess the feasibility of using a bespoke mobile application running on participants’ own handsets for the longitudinal (6 months) monitoring of antenatal mood and screening of depression. Methods and analysis:We will use a randomised controlled study design to compare two types of assessment strategies: retrospective + momentary (consisting of the Edinburgh Postnatal Depression Scale plus 5 momentary and 2 contextual questions), and retrospective (consisting of the Edinburgh Postnatal Depression Scale only). We will assess the impact that these strategies have on participant adherence to a pre-specified sampling protocol, drop-out rates and timeliness of data completion. We will evaluate differences in acceptance of the technology through a short quantitative survey and open ended questions. We will also assess the potential effect that momentary assessments could have on retrospective data. We will attempt to identify any patterns in app usage through the analysis of log data. Ethics and dissemination: This study has been approved by the South East Coast – Surrey Research Ethics Committee. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers. Registration details: This study has been registered in ClinicalTrials.gov under the identifier NCT02516982. STRENGTHS OF

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Marcano Belisario JS, Gupta AK, O'Donoghue JM, Ramchandani P, Morrison C, Car Jet al., 2017, Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study, BMC Medical Informatics and Decision Making, Vol: 17, ISSN: 1472-6947

BackgroundMobile devices may facilitate depression screening in the waiting area of antenatal clinics. This can present implementation challenges, of which we focused on survey layout and technology deployment.MethodsWe assessed the feasibility of using tablet computers to administer a socio-demographic survey, the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to 530 pregnant women attending National Health Service (NHS) antenatal clinics across England. We randomised participants to one of two layout versions of these surveys: (i) a scrolling layout where each survey was presented on a single screen; or (ii) a paging layout where only one question appeared on the screen at any given time.ResultsOverall, 85.10% of eligible pregnant women agreed to take part. Of these, 90.95% completed the study procedures. Approximately 23% of participants answered Yes to at least one Whooley question, and approximately 13% of them scored 10 points of more on the EPDS. We observed no association between survey layout and the responses given to the Whooley questions, the median EPDS scores, the number of participants at increased risk of self-harm, and the number of participants asking for technical assistance. However, we observed a difference in the number of participants at each EPDS scoring interval (p = 0.008), which provide an indication of a woman’s risk of depression. A scrolling layout resulted in faster completion times (median = 4 min 46 s) than a paging layout (median = 5 min 33 s) (p = 0.024). However, the clinical significance of this difference (47.5 s) is yet to be determined.ConclusionsTablet computers can be used for depression screening in the waiting area of antenatal clinics. This requires the careful consideration of clinical workflows, and technology-related issues such as connectivity and security. An association between survey layout and EPDS scoring intervals needs to be ex

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Iles J, Rosan C, WIlkinson E, Ramchandani Pet al., 2017, Adapting and developing a video-feedback intervention for co-parents of infants at risk of externalising behaviour problems (VIPP-Co): A feasibility study, Clinical Child Psychology and Psychiatry, Vol: 22, Pages: 483-499, ISSN: 1461-7021

Background:Recent research on early interventions with parents of infants at risk of externalising behaviour problems indicates that focusing on co-parenting and involving fathers in treatment may enhance effectiveness. This article reports the development and preliminary evaluation of a brief intervention: video-feedback intervention to promote positive parenting and sensitive discipline for co-parents (VIPP-Co).Methods:Families who reported to be struggling with their infant’s behaviour were recruited from the community and received six home-based sessions of VIPP-Co. The primary outcome was feasibility of the adapted intervention, assessed using semi-structured questionnaires and interviews post-intervention. Preliminary clinical outcome measures were also recorded.Results:In total, five families with infants between 10 and 24 months completed the intervention. Feedback data documented high rates of acceptability and feasibility. All fathers and mothers completing the intervention reported that it positively impacted their understanding of their child’s thoughts and feelings, as well as their approach to individual parenting and co-parenting. Additional preliminary outcome data indicated positive changes in parent–chid interaction and a positive trend was found for infant behaviour, parental well-being and parent relationship adjustment across the intervention.Conclusions:The overall results of this study are encouraging, but VIPP-Co must be evaluated with larger samples to explore its efficacy.

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Sethna V, Perry E, Domoney J, Iles J, Psychogiou L, Rowbotham N, Stein A, Murray L, Ramchandani Pet al., 2017, Father-child interactions at 3-months and 2 years: contributions to children’s cognitive development at 2 years, Infant Mental Health Journal, Vol: 38, Pages: 378-390, ISSN: 1097-0355

The quality of father-child interactions has become a focus of increasing research in the field of child development. We examined the potential contribution of father-child interactions at 3-months and 24-months to children’s cognitive development at 24-months. Observational measures of father-child-interactions at 3-months and at 24-months were used to assess the quality of fathers’ parenting (n=192). At 24 months, the Mental Developmental Index (MDI) of the Bayley’s Scales of Infant Development measured cognitive functioning. The association between interactions and cognitive development was examined using multiple linear regression analyses, adjusting for paternal age, education and depression, infant age, and maternal sensitivity. Children whose fathers displayed more withdrawn and depressive behaviours in father-infant interactions at 3-months, scored lower on the MDI at 24 months. At 24-months, children whose fathers were more engaged and sensitive, and those whose fathers were less controlling in their interactions, scored higher on the MDI. These findings were independent of the effects of maternal sensitivity. Results indicate that father-child interactions, even from a very young age (i.e. 3-months) may influence children’s cognitive development. They highlight the potential significance of interventions to promote positive parenting by fathers, and policies that encourage fathers to spend more time with their young children.

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Barker B, Iles J, Ramchandani P, 2017, Fathers, fathering and child psychopathology, Current Opinion in Psychology, Vol: 15, Pages: 87-92, ISSN: 2352-250X

The last few years have seen a steady increase in research addressing the potential influence of fathers on their children’s development. There has also been a clearer acknowledgement of the need to study families as a complex system, rather than just focussing on individual aspects of functioning in one orother parent. Increased father involvement and more engaged styles of father-infant interactions are associated with more positive outcomes for children. Studies of paternal depression and other psychopathology have begun to elucidate some of the key mechanisms by which fathers can influence their children’s development. These lessons arenowbeing incorporated into thinking about engaging both mothers and fathers in effectiveinterventions to optimise their children’s health and development.

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Ramchandani PG, 2016, Editorial: what are the concerns of a European child and adolescent psychiatrist?, European Child & Adolescent Psychiatry, Vol: 25, Pages: 1271-1272, ISSN: 1435-165X

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Herba CM, Glover V, Ramchandani PG, Rondon MBet al., 2016, Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries., Lancet Psychiatry, Vol: 3, Pages: 983-992, ISSN: 2215-0366

Studies examining mechanisms underlying associations between maternal depression and adverse child outcomes (including behaviour, socioemotional adjustment, and emotion regulation) indicate that during pregnancy, maternal depression could affect child outcomes through altered placental function, epigenetic changes in the child, and stress reactivity. Infection and dietary deficiencies in the mother and the child, together with the child's genetic vulnerability, might also affect outcome. Postnatally, associations between maternal depression and child outcome are influenced by altered mother-child interactions, sociodemographic or environmental influences, and social support. Knowledge is scarce on mechanisms in low-income and middle-income countries where maternal depression is highly prevalent, and stressful factors that influence the development of perinatal maternal depression and adverse child outcome (eg, food insecurity, perinatal infections, crowded or rural living conditions, and interpersonal violence) are both more intense and more common than in high-income countries. We reviewed evidence and use the biopsychosocial model to illustrate risk factors, mediators and moderators underlying associations between maternal depression and child outcomes in low-income and middle-income countries.

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Janssen AB, Capron LE, O'Donnell K, Tunster SJ, Ramchandani PG, Heazell AE, Glover V, John RMet al., 2016, Maternal prenatal depression is associated with decreased placental expression of the imprinted gene PEG3, Psychological Medicine, Vol: 46, Pages: 2999-3011, ISSN: 1469-8978

BACKGROUND: Maternal prenatal stress during pregnancy is associated with fetal growth restriction and adverse neurodevelopmental outcomes, which may be mediated by impaired placental function. Imprinted genes control fetal growth, placental development, adult behaviour (including maternal behaviour) and placental lactogen production. This study examined whether maternal prenatal depression was associated with aberrant placental expression of the imprinted genes paternally expressed gene 3 (PEG3), paternally expressed gene 10 (PEG10), pleckstrin homology-like domain family a member 2 (PHLDA2) and cyclin-dependent kinase inhibitor 1C (CDKN1C), and resulting impaired placental human placental lactogen (hPL) expression. METHOD: A diagnosis of depression during pregnancy was recorded from Manchester cohort participants' medical notes (n = 75). Queen Charlotte's (n = 40) and My Baby and Me study (MBAM) (n = 81) cohort participants completed the Edinburgh Postnatal Depression Scale self-rating psychometric questionnaire. Villous trophoblast tissue samples were analysed for gene expression. RESULTS: In a pilot study, diagnosed depression during pregnancy was associated with a significant reduction in placental PEG3 expression (41%, p = 0.02). In two further independent cohorts, the Queen Charlotte's and MBAM cohorts, placental PEG3 expression was also inversely associated with maternal depression scores, an association that was significant in male but not female placentas. Finally, hPL expression was significantly decreased in women with clinically diagnosed depression (44%, p < 0.05) and in those with high depression scores (31% and 21%, respectively). CONCLUSIONS: This study provides the first evidence that maternal prenatal depression is associated with changes in the placental expression of PEG3, co-incident with decreased expression of hPL. This aberrant placental gene expression could provide a possible mechanistic explanation for the co-occurrence of maternal depr

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Ramchandani P, wilkinson E, O'Mahen H, Fearon P, Halligan S, King D, Greenfield G, Dunkley Bent J, Ericksen J, Milgrom Jet al., 2016, Adapting and testing a brief intervention to reduce maternal anxiety during pregnancy (ACORN): study protocol for a randomized controlled trial, Trials, Vol: 17, ISSN: 1745-6215

BackgroundNational guidelines in the United Kingdom, United States of America, Canada, and Australia haverecently stressed the importance of identifying and treating antenatal anxiety and depression.However, there is little research into the most effective and acceptable ways of helping womenmanage their symptoms of anxiety and stress during pregnancy. Research indicates the necessity toconsider the unique needs and concerns of perinatal populations to ensure treatment engagement,highlighting the need to develop specialised treatments which could be integrated within routineantenatal healthcare services. This trial aims to develop a brief intervention for antenatal anxiety,with a focus on embedding the delivery of the treatment within routine antenatal care.Methods/DesignThis study is a two-phase feasibility trial. In phase one we will develop and pilot a brief interventionfor antenatal anxiety, blended with group support, to be led by midwives. This intervention will drawon cognitive behavioural principles and wider learning from existing interventions that have beenused to reduce anxiety in expectant mothers. The intervention will then be tested in a pilotrandomised controlled trial in phase two. The following outcomes will be assessed: i) number ofparticipants meeting eligibility criteria; ii) number of participants consenting to the study; iii) numberof participants randomised; iv) number of sessions completed by those in the intervention arm; andv) number of participants completing the post-intervention outcome measures. Secondary outcomescomprise: detailed feedback on acceptability, which will guide further development of theintervention; and outcome data on symptoms of maternal and paternal anxiety and depression,maternal quality of life, quality of couple relationship, mother-child bonding, infant temperamentand infant sleep.2DiscussionThe study will provide important data to inform the design of a future full-scale randomisedcontrolled trial of a brief inte

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Forti-Buratti MA, Saikia R, Wilkinson EL, Ramchandani PGet al., 2016, Psychological treatments for depression in pre-adolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials., European Child & Adolescent Psychiatry, Vol: 25, Pages: 1045-1054, ISSN: 1435-165X

The objective of this study was to evaluate the efficacy of psychological treatments for depression in pre-adolescent children, a disorder affecting 1-2 % of children in this age range. A systematic review of studies of psychological interventions to treat depressive disorder in pre-adolescent children (aged up to 12-years-old) was carried out. The primary outcome was level of depressive symptoms. Studies were found using Medline, PsycINFO, EMBASE and Web of Knowledge databases and selected on several criteria. Only randomised controlled trials were included. Where individual studies covered a broader age range (usually including adolescents up to age 18 years), authors of those studies were contacted and requested to provide individual patient level data for those aged 12 years and younger. 2822 abstracts were reviewed, and from these 124 full text articles were reviewed, yielding 7 studies for which we were able to access appropriate data for this review. 5 of these studies evaluated cognitive behaviour therapy (CBT). Combined results from these studies suggest that there is a lack of evidence that CBT is better than no treatment [standard mean difference -0.342 (95 % confidence interval -0.961, 0.278)], although the number of participants included in the trials was relatively small. The evidence for efficacy of family therapy and psychodynamic therapy is even more limited. The very limited number of participants in randomised controlled trials means that there is inconclusive evidence for the psychological treatment of depression in children aged 12 years and below. Given the prevalence and significant impact of this disorder, there is an urgent need to establish the effectiveness or otherwise of psychological intervention.

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Braithwaite EC, Murphy SE, Ramchandani PG, 2016, Effects of prenatal depressive symptoms on maternal and infant cortisol reactivity., Archives of Womens Mental Health, Vol: 19, Pages: 581-590, ISSN: 1434-1816

Prenatal depression is associated with adverse offspring outcomes, and the prevailing mechanistic theory to account for mood-associated effects implicates alterations of the maternal and foetal hypothalamic-pituitary adrenal (HPA) axes. Recent research suggests that depression may be associated with a failure to attenuate cortisol reactivity during early pregnancy. The aim of the current study is to investigate whether this effect continues into mid and late gestation. A further aim is to test whether maternal prenatal cortisol reactivity directly predicts infant cortisol reactivity. One hundred three pregnant women were recruited during either the second or third trimester. Depressive symptoms were assessed by self-report, and maternal salivary cortisol responses to a stressor (infant distress film) were measured. Approximately 2 months after birth, mothers (n = 88) reported postnatal depression and infant salivary cortisol responses to inoculation were measured. Prenatal depression was not associated with cortisol reactivity to acute stress in mid and late pregnancy. Similarly, neither prenatal depression nor maternal prenatal cortisol reactivity predicted infant cortisol reactivity to inoculation at 2 months. If the effects of prenatal depression on foetal and infant development are mediated by alterations of the maternal and foetal HPA axes, then early pregnancy may be a particularly vulnerable period. Alternatively, changes to HPA reactivity may not be as central to this association as previously thought.

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Dubicka B, Cole-King A, Reynolds S, Ramchandani Pet al., 2016, SUICIDALITY AND AGGRESSION DURING ANTIDEPRESSANT TREATMENT Paper on suicidality and aggression during antidepressant treatment was flawed and the press release was misleading, BMJ-BRITISH MEDICAL JOURNAL, Vol: 352, ISSN: 1756-1833

JOURNAL ARTICLE

Ramchandani PG, King DX, 2016, Treatment of maternal perinatal depression in a low-income setting does not lead to improved outcomes for children., Evidence-Based Mental Health, Vol: 19, Pages: 57-57, ISSN: 1468-960X

ABSTRACT FROM: Maselko J, Sikander S, Bhalotra S, et al. Effect of an early perinatal depression intervention on long-term child development outcomes: follow-upof the Thinking Healthy Programme randomised controlled trial. Lancet Psychiatry 2015;2:609–17.

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