Shivani Sharma

EXPLORING THE VIEWS OF PATIENTS NOT ON THE TRANSPLANT WAITING LIST: A QUALITATIVE STUDY

BACKGROUND Not all patients are suitable for kidney transplantation; however, little is known about the views and attitudes of patients who are not on the waiting list for transplantation. OBJECTIVE This study aimed to determine the views and attitudes of patients who are not on the waiting list regarding the process of transplant allocation. METHODS A grounded theory approach was used to develop theories from patient views, opinions and attitudes. Patients receiving dialysis, and not on the waiting list at a United Kingdom renal unit were identified by the renal counsellor and invited to take part. Five patients formed a focus group to enable construction of an interview schedule. Patients (n=10, different from those in the focus group) were interviewed until themes became saturated. Interview transcripts generated conceptual categories. RESULTS Seven conceptual categories emerged regarding access to transplantation. Patients experience emotions of loss relating to transplantation exacerbated by restrictions imposed by dialysis. Patients find coping mechanisms, accept their situation and trust that clinical decisions were equitable. CONCLUSIONS Patients trust their carers and support an efficacy argument when considering scarce resources. Communication should be improved to ensure clarity and understanding of clinical decisions.

Identifying Depression in South Asian Patients with End-Stage Renal Disease: Considerations for Practice

Depression is a prevalent burden for patients with end-stage renal disease (ESRD) and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific) and etic (universal or culture-general) screening instruments.

To admit or not to admit? The effect of framing on risk assessment decision making in psychiatrists

Abstract Background: The way that information is presented is well known to induce a range of biases in human decision tasks. Little research exists on framing effects in psychiatric decision making, but it is reasonable to assume that psychiatrists are not immune and, if so, there may be implications for the welfare of patients, staff and the general public. Aims: To investigate whether presentation of risk information in different formats (frequency, percentage and semantic) influences inpatient admission decisions by psychiatrists. Methods: Six-hundred seventy-eight general adult psychiatrists read a short clinical vignette presenting a case scenario of a patient presenting for inpatient admission. One of four condition questions followed the vignette, incorporating either numerical or percentage probabilities and the semantic labels “high” and “low” risk. In each condition, the actual risk was identical, but the way it was presented varied. The decision to admit the patient or not was recorded and compared across conditions. Results: More individuals chose to admit the patient when risk information was presented in numerical form (X2 = 7.43, p = 0.006) and with the semantic label “high” (X2 = 7.27, p = 0.007). Conclusions: Presentation of risk information may influence decision making in psychiatrists. This has important implications for mental health clinical practice where clinicians are required to interpret probabilistic information within their daily work.

Feasibility study of a randomised controlled trial to investigate the effectiveness of using a humanoid robot to improve the social skills of children with autism spectrum disorder (Kaspar RCT): a study protocol

Introduction Interventions using robot-assisted therapy may be beneficial for the social skills development of children with autism spectrum disorder (ASD); however, randomised controlled trials (RCTs) are lacking. The present research aims to assess the feasibility of conducting an RCT evaluating the effectiveness of a social skills intervention using Kinesics and Synchronisation in Personal Assistant Robotics (Kaspar) with children with ASD. Methods and analysis Forty children will be recruited. Inclusion criteria are the following: aged 5–10 years, confirmed ASD diagnosis, IQ over 70, English-language comprehension, a carer who can complete questionnaires in English and no current participation in a private social communication intervention. Children will be randomised to receive an intervention with a therapist and Kaspar, or with the therapist only. They will receive two familiarisation sessions and six treatment sessions for 8 weeks. They will be assessed at baseline, and at 10 and 22 weeks after baseline. The primary outcome of this study is to evaluate whether the predetermined feasibility criteria for a full-scale trial are met. The potential primary outcome measures for a full-scale trial are the Social Communication Questionnaire and the Social Skills Improvement System. We will conduct a preliminary economic analysis. After the study has ended, a sample of 20 participants and their families will be invited to participate in semistructured interviews to explore the feasibility and acceptability of the study’s methods and intervention. Ethics and dissemination Parents/carers will provide informed consent, and children will give assent, where appropriate. Care will be taken to avoid pressure or coercion to participate. Aftercare is available from the recruiting NHS Trust, and a phased withdrawal protocol will be followed if children become excessively attached to the robot. The results of the study will be disseminated to academic audiences and non-academic stakeholders, for example, families of children with ASD, support groups, clinicians and charities. Trial registration number ISRCTN registry (ISRCTN14156001); Pre-results.

Same Traits, Different Variance: Item-Level Variation Within Personality Measures

Personality trait questionnaires are regularly used in individual differences research to examine personality scores between participants, although trait researchers tend to place little value on intra-individual variation in item ratings within a measured trait. The few studies that examine variability indices have not considered how they are related to a selection of psychological outcomes, so we recruited 160 participants (age M = 24.16, SD = 9.54) who completed the IPIP-HEXACO personality questionnaire and several outcome measures. Heterogenous within-subject differences in item ratings were found for every trait/facet measured, with measurement error that remained stable across the questionnaire. Within-subject standard deviations, calculated as measures of individual variation in specific item ratings within a trait/facet, were related to outcomes including life satisfaction and depression. This suggests these indices represent valid constructs of variability, and that researchers administering behavior statement trait questionnaires with outcome measures should also apply item-level variability indices.

A Personal Construct Approach to Understanding Stress in Mothers of Children Diagnosed with Autism Spectrum Disorders

This study explored the contribution of personal construct psychology (PCP) and the repertory grid technique to understanding stress when raising a child diagnosed with autism spectrum disorder (ASD). Associations between child level of functional impairment, parenting stress, psychological distress, and maternal construing were examined in mothers of 25 children diagnosed with ASD. Results suggest that a personal construct perspective may help delineate factors involved in parent adjustment to ASD.

How do people of South Asian origin understand and experience depression? A protocol for a systematic review of qualitative literature

Introduction Individuals from Black and Asian Minority Ethnic (BAME) groups are less likely to receive a diagnosis and to engage with treatment for depression. This review aims to draw on international literature to summarise what is known about how people specifically of South Asian origin, migrants and non-migrants, understand and experience depressive symptoms. The resulting evidence base will further inform practices aimed at encouraging help-seeking behaviour and treatment uptake. Methods and analysis A systematic review and thematic synthesis of qualitative literature conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Using predefined inclusion and exclusion criteria, electronic searches will be conducted across 16 databases. Study quality will be assessed using the Critical Appraisal Skills Programme (CASP). Data will be extracted independently by 2 reviewers. Ethics and dissemination Ethical approval is not required. A comprehensive evidence base of how people from South Asian backgrounds conceptualise and experience depression will better inform the design and delivery of mental health initiatives and advance directions for future research. Findings will be published in a peer-reviewed journal, and disseminated through existing networks for professionals, researchers, patients and the public. Trial registration number CRD42015026120.

F7. SEX DIFFERENCES IN THE ASSOCIATION BETWEEN SELF-REPORTS OF CHILDHOOD ADVERSITIES AND SCHIZOTYPAL PERSONALITY TRAITS

Abstract Background While it has been repeatedly documented that people with schizophrenia report higher levels of adverse events in childhood (emotional, physical and sexual abuse), this has not been extensively examined in healthy individuals who score highly on schizotypal personality traits. The continuum hypothesis of psychosis and schizophrenia suggests it is important to assess the relationship in those who are healthy but who experience some psychotic-like symptoms. Of course, it is problematic to rely upon the veracity of events that anyone might recall from their childhood, but this is likely to be compounded by the presence of well-documented memory and executive problems, as well as symptoms such as delusional thinking, in some adults with psychosis. One advantage of examining healthy participants is that recall is not affected by the condition itself or memory- and executive-function problems. As there is evidence that the expression of psychotic disorders differ between males and females, the etiological mechanisms and pathways to the development and experience of psychotic symptoms may equally differ. Indeed, sex differences in the association between childhood trauma and psychotic symptoms have been noted. The aim of this present study was to investigate any links between childhood trauma and psychotic-like symptoms in healthy individuals. Based on previous research the expectation is that associations will be found between self-reports of childhood trauma and schizotypal personality traits. These associations would be expected to differ between males and females. Methods The sample consisted of 320 participants (221 females, 99 males) with a mean age of 28.24 (SD 12.76). Childhood traumatic events were assessed by three sub-scales (Physical Punishment; Emotional Abuse; and Sexual Events) of the Early Trauma Inventory Self Report-Short Form (ETISR-SF; Bremner et al., 2007). Schizotypal personality traits were assessed using the Five Factor Schizotypal Inventory (FFSI; Edmundson et al., 2011). This consists of nine subscales (Interpersonal Suspiciousness; Social Anhedonia; Social Isolation and Withdrawal; Physical Anhedonia; Social Anxiousness; Social Discomfort; Odd and Eccentric; Aberrant Ideas; and Aberrant Perceptions) which were constructed as schizotypic variants of respective facets of the five factor personality model. Results The relationship between childhood trauma and schizotypy was examined using Spearman’s bivariate correlation analyses. Males showed significant positive correlations (ranging from .28 to .39) between Emotional Abuse and seven out of nine schizotypal sub-scales. The other two childhood trauma scales were not associated with any schizotypal sub-scales in males. Females showed significant positive correlations (ranging from .19 to .34) between Physical Punishment and eight out of nine schizotypal sub-scales. Additionally, females showed significant positive correlations (ranging from .26 to .35) between Emotional Abuse and all schizotypal sub-scales. Sexual Events positively correlated with two schizotypal sub-scales (Aberrant Ideas and Aberrant Perceptions) in females. Discussion From the results of this study it appears that emotional abuse was linked to the expression of psychotic-like symptoms in both sexes across a wide array of symptomatology. Therefore, any effect of emotional abuse should not be considered sex or symptom specific. By contrast, physical abuse appeared to be sex specific – affecting only females – but not symptom specific. Finally, sexual abuse appeared to have a specific link with disorganized thoughts and hallucination-like experiences in females.

Sex differences in the association between childhood adversities and schizotypal personality traits

Patients with psychosis report higher levels of adverse events in childhood. This relationship has not been extensively examined in healthy individuals who score highly on schizotypal personality traits. This study examined the association between different childhood traumas and psychosis-like traits in a general population sample, as well as differences in those links between men and women. Participants completed an online survey including measures of physical, emotional, and sexual abuse, and schizotypal personality traits. Results showed that the experience of emotional abuse was associated with a range of both positive and negative psychosis-like traits in both sexes. Sex differences emerged in the association between physical abuse and schizotypal personality traits. Although men reported more physical abuse in early life than women, this type of trauma was only associated with schizotypal traits in women and not in men. Additionally, women scored higher than men in sexual abuse; however, sexual abuse did not explicitly predict any schizotypal traits in the presence of the other two types of abuse. A simple linear or dose-response relationship between different types of trauma and psychosis-like traits was not supported. The importance of emotional abuse on schizotypy was highlighted in both sexes.

Variation in Personality States as Predicted by Interpersonal Context

Diary studies of personality have shown that personality is variable, and can help the person deal appropriately with the different interpersonal demands they encounter. This study aims to demonstrate how interpersonal context predicts personality states. Thirty-six participants (9 male, 27 female, Mage = 24.72, SD = 7.11) kept an online diary for one month. The diary recorded measurements of HEXACO personality states, momentary interpersonal factors including current interpersonal role (with friend, family member, partner, as employee/student, alone), and social goal orientation (socializing with others, avoidance of others, asserting yourself, personal/work achievement), and dispositional anxiety and depression. Individuals’ personality states were found to vary considerably across measurements in a normal distribution. Multilevel modelling analyses showed that interpersonal factors did predict within subject personality variation. Social goal orientations had a greater relative impact than interpersonal roles. Depression had a significant effect on between subject variance in state emotionality. These findings highlight the importance of interpersonal context in predicting stable personality variation.