Emily Robinson

Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009–2015

To investigate whether public knowledge, attitudes, desire for social distance and reported contact in relation to people with mental health problems have improved in England during the Time to Change (TTC) programme to reduce stigma and discrimination 2009–2015.

Viewpoint survey of mental health service users' experiences of discrimination in England 2008-2014.

Discrimination reported by mental health service users in England is high. The study aims to determine changes in mental health‐related discrimination from 2008 to 2014.

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

Background Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective To describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.

Relationships between anti-stigma programme awareness, disclosure comfort and intended help-seeking regarding a mental health problem

Background Anti-stigma programmes should aim to increase disclosure to those who can support someone with a mental health problem and appropriate professional help-seeking. Aims We investigated associations among public awareness of Englands Time to Change anti-stigma campaign and: (a) comfort envisaged in disclosing a mental health problem to family and friends; (b) comfort in disclosing to an employer; and (c) intended professional help-seeking from a general practitioner, i.e. a physician working in primary care. Method Using data from a survey of a nationally representative sample of adults, we created separate logistic regression models to test for campaign awareness and other variables as predictors of comfort in disclosure and intended help-seeking. Results We found positive relationships between campaign awareness and comfort in disclosing to family and friends (odds ratio (OR) = 1.27, 95% CI 1.14–1.43) and to a current or prospective employer (OR=1.20, 95% CI 1.06–1.35); and likelihood of help-seeking (OR=1.18 95% CI 1.03–1.36). Conclusions Awareness of an anti-stigma campaign was associated with greater comfort in disclosing a mental health problem and intended help-seeking.

The effectiveness of a group self-management education course for adults with poorly controlled epilepsy, SMILE (UK): A randomized controlled trial

Epilepsy is one of the most common neurological conditions affecting about 1% of adults. Up to 40% of people with epilepsy (PWE) report recurring seizures while on medication. And optimal functioning requires good self‐management. Our objective was to evaluate a group self‐management education courses for people with epilepsy and drug‐resistant seizures by means of a multicenter, pragmatic, parallel group, randomized controlled trial.

Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial

BACKGROUND Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN A parallel pragmatic randomised controlled trial. SETTING Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.

Erratum: Attention training for infants at familial risk of ADHD (INTERSTAARS): Study protocol for a randomised controlled trial. [Trials., 17, (2016) (608)] DOI: 10.1186/s13063-016-1727-0

Author details Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK. Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK. MRC Social, Genetic and Developmental Psychiatry Centre, IoPPN, King’s College London, London, UK. NIHR Biomedical Research Centre at South London and Maudsley NHS Trust, London, UK. Department of Psychology, IoPPN, King’s College London, London, UK. Department of Biostatistics, IoPPN, King’s College London, London, UK. Department of Psychological Sciences, Birkbeck, University of London, London, UK. Department of Psychology, University of Southampton, Southampton, UK. Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium. School of Psychology, University of East London, London, UK. Department of Psychology, University of Cambridge, Cambridge, UK.

PO055 Results of an rct of self-management education in epilepsy: smile-uk

Introduction People with epilepsy (PWE) want to learn about self-management. No course tested in UK. Methods Mixed-methods RCT evaluating group 2 day self-management education for poorly controlled epilepsy. Participants’ characteristics described at baseline, a sub-sample purposefully interviewed at 6 months, outcomes analysed at 1 year. Outcomes: primary, quality of life (QOLIE-31-P); secondary: seizure frequency, psychological distress, self-mastery and felt-stigma. Results Enrolled 404 participants with median 18 years since diagnosis, 69%≥10 seizures in the prior year, 46% reported co-morbidity, 64% current anxiety, 28% borderline or case-level depression, and 63% felt stigmatised. Participants’ mean QOLIE-31-P was 66 out of 100 (range 25–99). In decreasing order, associated with low QOLIE-31-P: depression, low self-mastery, anxiety, feeling stigmatised, history of medical/psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency. Process evaluation interviews found that PWE felt socially isolated. They gained confidence from interactive groups. Results at 1 year outcome will be presented. Conclusions PWE and persistent seizures experience low QoL, with psychological and social characteristics more closely associated than clinical characteristics. Group learning helps PWE overcome isolation and gain confidence. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.

AN RCT OF SELF-MANAGEMENT EDUCATION IN EPILEPSY: PARTICIPANTS AT BASELINE

Background We are doing a multicentre, randomised controlled trial evaluating the effectiveness and cost-effectiveness of a two-day Self-Management education course for epILEpsy (SMILE (UK)), which was developed in Germany (MOSES). Methods We recruited participants attending epilepsy clinics in SE England, reporting 2 or more seizures in the prior year. The primary outcome is patient-reported quality of life. Secondary outcomes include seizure frequency, psychological distress, and stigma among other variables. This presentation describes important characteristics of participants at baseline. Results Of 404 participants recruited, mean age was 42 years, 75% were of white ethnicity, and 46% were male. Epilepsy had been diagnosed a median of 18 years previously, 72% reported one or more seizures in the prior month, and 46% reported another significant medical and/or psychological condition. Psychological distress symptoms endorsed on the Hospital Anxiety and Depression Scale suggest case or borderline case rates of Anxiety of 54%, and of Depression of 28%. The average epilepsy-specific quality-of-life (QOLIE-31) score was 66 (maximum 100). Discussion This group of participants recruited via epilepsy clinics had chronic, poorly controlled epilepsy. About half reported other significant conditions and borderline or case-level symptoms of anxiety. The relationship between these and other characteristics will be presented.