Karen Kirby

Risk factors for psychological distress in Northern Ireland

Background: Stress-related mental ill health and its disorders are considered by the World Health Organization (WHO) to be the new world epidemic and their prevalence rates seem to be increasing worldwide. Aims: To examine and identify sub-populations at risk for psychological discomfort in Northern Ireland and map the relative impact of potential predictors. Methods: A sample of 4,638 respondents to the NIHSW-2001 survey was analysed with latent class analysis and latent class factorial analysis. Latent class multinomial logistic regression assessed the impact of a range of predictors on class membership. Results: Five sub-populations were differentiated. All subgroups at risk for anxiety and depression were characterized as being younger and female. Disability and adverse life events were strong predictors of risk. Long-standing illness and housing worries were predictors of medium and high risk membership. The effect of civil unrest was significant only for the medium-risk subgroup; marital status and income did not affect group membership. Conclusions: Because all five subgroups showed a different probability, but a similar profile of endorsing GHQ-12 items, it could be hypothesized that an underlying continuum dimension of anxiety and depression is present in the Northern Irish population.

What type of service provision do patients with chronic pain want from primary care providers

Purpose. The aim of this study was to explore what types of service provision patients with chronic pain wanted from their general practitioners (GP). Method. A small scale survey measured anxiety and depression and quantified the extent to which patients wanted four different types of help from their GP (explanation and understanding, medical treatment, psychological support and information). An opportunistic sample of 155 patients (30.3% male and 69.7% female) was recruited from three general practice surgeries in the northwest region of Northern Ireland. Ninety-one participants self-reported chronic pain and there were 64 in the no pain group. Results. Even after statistically controlling for anxiety and depression, individuals in the chronic pain group had a greater need for emotional/psychological support and explanation and understanding from their GPs. There were no significant differences between the groups with respect to the need for more information or medical treatment. Conclusions. A biopsychosocial approach should be employed in the management of chronic pain, however as this study shows, some primary care patients are still being treated within a biomedical framework. To address the unmet needs of this patient population, there is a need for clinical guidelines in the management of chronic pain in primary care settings. Limitations of the present research, with recommendations for future study are offered.

School-based Interventions to Reduce Sedentary Behaviour in Children: A Systematic Review

Introduction Prolonged, uninterrupted periods of sedentary time may be associated with increased risk of Type II diabetes, cardiovascular disease and all-cause mortality even if the minimum recommended levels of daily physical activity are achieved. It is reported that children spend approximately 80% of their day engaged in sedentary behaviours. Since children spend a large portion of their waking time at school, school-based interventions targeting excessive or interrupted periods of sedentary time have been investigated in a number of studies. However, results of the effectiveness of studies to-date have been inconsistent. Aim To conduct a systematic review to evaluate the effectiveness of school-based interventions designed to reduce sedentary behaviour on objectively measured sedentary time in children. Methods Five electronic databases were searched to retrieve peer-reviewed studies published in English up to and including August 2015. Studies that reported objectively measured sedentary time before and after a school-based intervention to reduce sedentary time were included in the review. Risk of bias was assessed using the Cochrane Collaboration method. Results Our search identified eleven papers reporting eight interventions. Studies focused on the physical environment, the curriculum, individual in-class activities, homework activities or a combination of these strategies. Three studies reported decreases in sedentary time following intervention. Study follow-up periods ranged from immediately post-intervention to 12 months. None of the studies were judged to have a low risk of bias. Conclusions Multicomponent interventions which also include the use of standing desks may be an effective method for reducing childrens sedentary time in a school-based intervention. However, longer term trials are needed to determine the sustained effectiveness of such interventions on childrens sedentary time.

The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study

BackgroundThe aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period.MethodsAdministrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of ‘chest pain’ presentation and the subsequent diagnoses for each year.ResultsBoth chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year. In total, 58.7% of all chest presentations across 3 years resulted in a non-cardiac diagnosis of either ‘anxiety’, ‘panic’ or ‘chest pain of unknown cause’.DiscussionThere is a significant amount of patients in the ED leaving with a non-cardiac diagnosis, following an initial presentation with chest pain. ConclusionGiven the link between non-cardiac chest pain and frequent use of services, the degree of repeat attendance should be investigated.

A Pilot Investigation of a Parenting Intervention for Parents and Children with Neurodevelopmental Disorders (NDD)

ABSTRACT Purpose: Research is only beginning to address the extent to which evidence-based parenting programmes have utility and merit within populations of children and families with neurodevelopmental disorders (NDD). The purpose of this paper is to evaluate a parent-focused intervention for families who have a child with a NDD and investigate whether this type of intervention could improve parental self-efficacy; child behaviour, and child quality of life (QoL). Design/methodology/approach: In total five families caring for a child with a NDD participated in an evidenced-based parenting programme. A repeated measures design was employed to measure parental self-efficacy levels, child behaviour and child QoL. Glass’s delta was used to measure effect sizes. Findings: Clinically significant improvements from pre to post-intervention were noted in seven of the eight parenting domains and seven of the ten child behaviour domains assessed, with medium to large effect sizes reported. Research limitations/implications: It was anticipated that children would benefit indirectly through the intervention, however this was not supported. Practical implications: This research adds to the evidence base on the potential for parent-focused interventions within NDD. Originality/value: These findings support the potential effectiveness of parenting programmes in NDD populations.

Comparing Self-Harm (SH) Thoughts and Behaviours Among a Community Sample of Younger and Older Adolescents in Northern Ireland

ABSTRACT Background: Clinical data indicate that the rates of non-suicidal self-harm (SH) are rising and developing younger, causing increasing concern. However, to date, no United Kingdom (UK), Irish or European community based surveys have been able to determine the prevalence rates of not only SH ideation but also actual incidences of SH behaviours in younger adolescent groups (11–14 years). Hence the aim of the current study was to establish an estimate of how SH may be developing in children as young as 11 up to 14 years, and compare these rates with more established older adolescent age groups of 15 up to 18 years. Method: A cross-sectional online survey design was used, where a total of 864 adolescents (56% female, n = 480), aged from 11 up to 18 years, were recruited from four post-primary schools in the north-west region of NI. Results: The rates of SH ideation in the younger adolescents (11–14 years) was reported to be 7.9%, and SH behaviours was 5.7%. When compared to the older adolescents (15–18 years), the rate of SH ideation was reported to be 18.5%, and the rate of SH behaviours was 12.5% (which are comparable to others parts of UK, Republic of Ireland and Europe). Females are more at risk of SH ideation and behaviours than males in both age groups. Conclusion: SH ideation and SH behaviours are developing at a much younger age than was previously considered in school-based community settings. Recommendations for future research studies include lowering the age threshold of participant samples and focusing on female adolescents in order to explore the prevalence of SH ideation and behaviours in this vulnerable group. Tentative theories have been suggested regarding the use of social media, social comparison, perfectionism and contagion as potential predictors which require further exploration in relation to adolescent SH ideation and SH behaviours.