Chris Papadopoulos

Psychological disorder amongst refugee and migrant schoolchildren in London

Abstract.Background:Refugee and migrant children are likely to be exposed to many of the risk factors for emotional and behavioural problems. These children form a significant proportion of the school population in London and other inner cities in the UK. However, there are very little epidemiological data available on their mental health. In this study, we aimed to examine the prevalence of psychological problems among refugee and migrant schoolchildren compared to their UK-born peers.Method:A cross-sectional investigation using the Strengths and Difficulties Questionnaire (SDQ) examined in association with socio-demographic variables including language preference.Results:Almost a quarter of schoolchildren might be described as having a need, with migrant and refugee children showing greater psychological distress on a number of the sub-scales of the SDQ. Language appears to be an important variable associated with distress.

A review and meta‐analysis of the patient factors associated with psychiatric in‐patient aggression

To combine the results of earlier comparison studies of in‐patient aggression to quantitatively assess the strength of the association between patient factors and i) aggressive behaviour,ii) repetitive aggressive behaviour.

The antecedents of violence and aggression within psychiatric in-patient settings

Papadopoulos C, Ross J, Stewart D, Dack C, James K, Bowers L. The antecedents of violence and aggression within psychiatric in‐patient settings.

Safewards: the empirical basis of the model and a critical appraisal

Accessible summary In the previous paper we described a model explaining differences in rates of conflict and containment between wards, grouping causal factors into six domains: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. This paper reviews and evaluates the evidence for the model from previously published research. The model is supported, but the evidence is not very strong. More research using more rigorous methods is required in order to confirm or improve this model. Abstract In a previous paper, we described a proposed model explaining differences in rates of conflict (aggression, absconding, self-harm, etc.) and containment (seclusion, special observation, manual restraint, etc.). The Safewards Model identified six originating domains as sources of conflict and containment: the patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and outside hospital. In this paper, we assemble the evidence underpinning the inclusion of these six domains, drawing upon a wide ranging review of the literature across all conflict and containment items; our own programme of research; and reasoned thinking. There is good evidence that the six domains are important in conflict and containment generation. Specific claims about single items within those domains are more difficult to support with convincing evidence, although the weight of evidence does vary between items and between different types of conflict behaviour or containment method. The Safewards Model is supported by the evidence, but that evidence is not particularly strong. There is a dearth of rigorous outcome studies and trials in this area, and an excess of descriptive studies. The model allows the generation of a number of different interventions in order to reduce rates of conflict and containment, and properly conducted trials are now needed to test its validity.

‘Individualism-Collectivism’ as an Explanatory Device for Mental Illness Stigma

The aim of this study is investigate whether the cross-cultural value paradigm ‘individualism-collectivism’ is a useful explanatory model for mental illness stigma on a cultural level. Using snowball sampling, a quantitative questionnaire survey of 305 individuals from four UK-based cultural groups (white-English, American, Greek/Greek Cypriot, and Chinese) was carried out. The questionnaire included the ‘Community Attitudes to Mental Illness scale’ and the ‘vertical-horizontal individualism-collectivism scale’. The results revealed that the more stigmatizing a culture’s mental illness attitudes are, the more likely collectivism effectively explains these attitudes. In contrast, the more positive a culture’s mental illness attitudes, the more likely individualism effectively explains attitudes. We conclude that a consideration of the individualism-collectivism paradigm should be included in any future research aiming to provide a holistic understanding of the causes of mental illness stigma, particularly when the cultures stigmatization levels are particularly high or low.

Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets

BackgroundOlder adults experience age-related physiological changes that increase sensitivity and decrease tolerance to alcohol and there are a number of age-related harms such as falls, social isolation and elder abuse, which are compounded by alcohol misuse. Despite this unique vulnerability and the fact that the number of older adults is increasing, the literature on drinking behaviour and alcohol-related harm in older adults is sparse. This article describes a secondary analysis of UK data to address this knowledge gap.MethodSecondary analysis of national statistics on alcohol-related hospital admissions and alcohol-related deaths, and data on drinking behaviour from the General Lifestyle Survey. Trends were identified by calculating percentage changes between time periods. The association between drinking behaviour and selected age groups was investigated using one way analysis of variance or chi-square tests.ResultsOlder adults (aged 65 and over) drink less and are less likely to exceed the recommended drink limits than younger adults. However, they are more likely to be admitted to hospital for an alcohol-related condition than younger adults and the most significant increases in alcohol-related hospital admission rates in recent years have occurred in older age groups. Alcohol-related death rates are highest amongst those aged 55–74 years old. Alcohol consumption and the prevalence of exceeding the recommended drink limits has fluctuated but not significantly increased in older adults in recent decades.ConclusionOlder adults experience high and increasing levels of alcohol-related harm and as the population ages, this is likely to put increasing pressure on health and social services. Careful monitoring and age-appropriate strategies to detect and treat older adults at risk of alcohol-related harm are required.

Events Preceding Changes in Conflict and Containment Rates on Acute Psychiatric Wards

OBJECTIVE The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced medication) events in acute inpatient psychiatric wards. METHODS Line graphs that mapped the total conflict and containment scores over two years on 16 acute inpatient psychiatric wards in the United Kingdom (London) were matched with chronological events that were documented in 120 qualitative semistructured interviews with ward managers and consultant psychiatrists during the same two-year period. Conflict and containment scores were derived from the validated Patient-Staff Conflict Checklist-Shift Report, which was completed by nurses at the end of each shift to log the frequency of conflict behaviors of patients and the staff containment measures. RESULTS A total of 463 score transitions (upturns and downturns) were identified in the graphs. A total of 323 events were matched to these transitions. A thematic analysis of these events produced 40 themes, which were organized into four categories: patient centered, staff centered, practice or ward centered, or other themes. Thirteen themes were significantly associated with conflict and containment score transitions, 11 of which were staff centered. For example, negative staff morale and staffing change resulting in a negative impact significantly increased the likelihood that conflict and containment would occur, whereas report of positive staff practice significantly decreased the likelihood of such events occurring. CONCLUSIONS The results support the theory that ward staff play a crucial role in influencing the likelihood that conflict or containment events will occur in inpatient psychiatric settings.

The mental health, quality of life and life satisfaction of internally displaced persons living in Nakuru County, Kenya

BackgroundInternally displaced persons (IDPs) are among the most vulnerable people in the world today. Previous research highlights that conflict-induced forced displacement can cause problems with mental health and wellbeing. This study aimed to contribute to this body of knowledge by investigating the mental health, quality of life, and life satisfaction among IDPs living in Nakuru, Kenya.MethodsA questionnaire that included the General Health Questionnaire-12, Satisfaction with Life Scale, and a modified version of the WHO Quality of Life-BREF tool was used for data collection. The questionnaire also included an open-ended question inviting qualitative responses about their experience as an IDP. The questionnaire was distributed through a three-stage sampling approach across four refugee camps from four regions of the Nakuru County in Kenya.ResultsOne hundred IDPs participated in this study. All participants scored substantially higher than the applied GHQ-12 threshold for caseness (mean GHQ-12 score = 28.7, SD = 3.6). Quality of life and life satisfaction scores were also very poor (M = 10.24, SD = 1.9; M = 6.82, SD = 1.5 respectively). The qualitative results reflected these findings with statements reflecting suicidal thoughts, unhappiness with the government, lack of support, and fear for themselves and their children. Significantly higher GHQ-12 scores were found among older IDPs (rho = .202, sig = .046), widowers compared to married IDPs (mean difference = −2.41, SE = .885, sig = .027), while lower scores were found among IDPs who reported having friends as a source of support (U = 834, sig = .045), while quality of life scores were higher among IDPs who reported receiving governmental support (U = 248, sig = .018).ConclusionThe findings revealed poor levels of mental health, quality of life and life satisfaction. Older, widowed IDPs and those who did not perceive support from friends or the government were found to be at the highest risk of poor health and wellbeing.

The effectiveness of HIV/AIDS school-based sexual health education programmes in Nigeria: A systematic review

HIV/AIDS is one of the most important public health challenges facing Nigeria today. Recent evidence has revealed that the adolescent population make up a large proportion of the 3.7% reported prevalence rate among Nigerians aged 15-49 years. School-based sexual health education has therefore become an important tool towards fighting this problem. This systematic review assesses the efficacy of these educational programmes and examines how future programmes and their evaluations can improve. Primary literature published between January 2002 and May 2012, which measured sexual health outcomes among school-based Nigerians before and after a sexual health education programme was delivered, was identified. All seven studies that met the inclusion and exclusion criteria showed there had been positive changes in outcomes following these educational programmes. These included increased knowledge, healthier attitudes and safer sexual health behaviour. However, these studies each had methodological flaws which highlighted a range of important design, implementation and evaluation challenges that future programmes need to meet.

Correlation Between Levels of Conflict and Containment on Acute Psychiatric Wards: The City-128 Study

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.