Ruth Spence

An Evaluation of New Services for Personality-Disordered Offenders: Staff and Service User Perspectives

Background: Little is known about effective treatment for personality-disordered (PD) offenders. We aimed to obtain the perspective of service users and staff on: (a) the experience of receiving treatment; and (b) the experience of delivering treatment, within new forensic services for PD offenders. Material: Thematic analysis was applied to qualitative interviews with 30 service users and 22 staff. Discussion: Service users perceived that they were making positive changes in the areas of anger management, communication, self-harm, self-esteem and insight into their difficulties. Undertaking the clinical work was extremely stressful for staff. Conclusions: Forensic PD services may be having an important impact on the quality of service users’ lives. Whether treatment is successful in reducing long-term risk to others remains to be seen, and the cost-effectiveness of these services needs to be examined.

Item response theory and validity of the NEO-FFI in adolescents

Highlights ► It is important to maximise the precision of personality measurement in adolescents. ► We apply item response theory (IRT) to the NEO-FFI in an adolescent sample. ► IRT was used to assess item validity and highlight poorly performing indicators. ► Removing poor items reduced measurement error without compromising validity. ► IRT analysis can be used to develop personality measures ensuring item validity.

The Longitudinal Psychometric Properties of the EAS Temperament Survey in Adolescence

Studies on the psychometric properties of the EAS Temperament Survey (EAS) have produced equivocal results. In particular the psychometrics of the EAS are largely unknown in adolescence. Confirmatory factor analysis was used to explore the EAS structure in adolescents. Structural equation modeling was also used to assess measurement invariance and factor stability. A modified 4-factor model provided the best fit to the data and demonstrated reasonable longitudinal invariance and stability. Furthermore, the standardized factor scores correlated at near unity with the sum of observed scores, suggesting factor interpretations remained unchanged. However, the modifications suggest that further work is necessary.

Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach

Background Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions. Objective (1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes. Methods The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches. Results The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015. Conclusions There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.

Help-seeking in emerging adults with and without a history of mental health referral: a qualitative study

BackgroundYoung people are generally reluctant to seek professional help when experiencing problems. However, past experience of services is often cited as increasing the intention to seek help, therefore those with a history of mental health referral may adopt more adaptive help seeking strategies. The current study investigated whether the pattern of different help seeking strategies and barriers to help seeking differed as a function of previous referral history.MethodsSemi-structured interviews were conducted with 29 emerging adults (12 males, 17 females); 17 with a history of mental health referral and 12 without and analysed using thematic analysis.ResultsOverall, those with a referral to services were more likely than those without to rely on avoidant coping, especially techniques that depended upon suppression. This could help account for the increased use of strategies involving self-harm and substances in those with past referral. An exploration of barriers to help seeking showed those with a history of mental health referral were much more likely to self-stigmatise and this became attached to their sense of identity.ConclusionsEmerging adults with a history of referral are more likely to adopt avoidant coping strategies when dealing with problems and self-stigmatise to a greater degree than those without a history of referral. This suggests that current approaches to mental health in emerging adults are not decreasing the sense of stigma with potentially far-reaching consequences for the developing sense of self and choice of help seeking strategies.

Factors Associated with Variation in Hospital Use at the End of Life in England

Objective To identify the relative importance of factors influencing hospital use at the end of life. Design Retrospective cohort study of person and health system effects on hospital use in the past 12 months modelling differences in admissions, bed days and whether a person died in hospital. Setting Residents in England for the period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals in England funded by the National Health Service (NHS). Participants 1 223 859 people registered with a GP in England who died (decedents) in England (April 2009–March 2012) with a record of NHS hospital care. Main outcome measures Hospital admissions, and hospital bed days and place of death (in or out of hospital) in the past 12 months of life. Results The mean number of admissions in the past 12 months of life averaged 2.28 occupying 30.05 bed days—excluding 9.8% of patients with no hospital history. A total of 50.8% of people died in hospital. Difference in hospital use was associated with a range of patient descriptors (age, gender and ethnicity). The variables with the greatest ‘explanatory power’ were those that described the diagnoses and causes of death. So, for example, 65% of the variability in the model of hospital admissions was explained by diagnoses. Only moderate levels of variation were explained by the hospital provider variables for admissions and deaths in hospital, though the impacts on total bed days was large. Conclusions Comparative analyses of hospital utilisation should standardise for a range of patient specific variables. Though the models indicated some degree of variability associated with individual providers, the scale of this was not great for admissions and death in hospital but the variability associated with length of stay differences suggests that attempts to optimise hospital use should look at differences in lengths of stay and bed use. This study adds important new information about variability in admissions by diagnostic group, and variability in bed days by diagnostic group and eventual cause of death.

The Computerised Life Events and Assessment Record (CLEAR) online measure of life events: reliability, validity and association with depression. (Preprint)

Background Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. Objective The objective of our study was to test CLEAR’s reliability, validity, and association with depression. Methods CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. Results CLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90). Conclusions CLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders.