is a Research Associate in psychiatric epidemiology in the PsyLife group, Division of Psychiatry, UCL. She is interested in researching life course risk factors of various mental health problems in childhood, adolescence and young adulthood as well as ways to improve access to mental health services. Jennifer Dykxhoorn is a PhD student in the PsyLife Lab, Division of Psychiatry, UCL. Her research focuses on social and spatial determinants of psychotic disorders. She has a background in public mental health policy, having previously worked for the Public Health Agency of Canada and Mental Health Commission of Canada. Dr James Kirkbride is a Reader in Epidemiology in the Division of Psychiatry, UCL. He specialises in investigating the determinants of excess risk of schizophrenia and other psychotic disorders experienced by urban populations and ethnic minority groups. He runs the PsyLife group (www.PsyLife.eu) in the Division of Psychiatry, UCL.

is a Research Associate in psychiatric epidemiology in the PsyLife group, Division of Psychiatry, UCL. She is interested in researching life course risk factors of various mental health problems in childhood, adolescence and young adulthood as well as ways to improve access to mental health services. Jennifer Dykxhoorn is a PhD student in the PsyLife Lab, Division of Psychiatry, UCL. Her research focuses on social and spatial determinants of psychotic disorders. She has a background in public mental health policy, having previously worked for the Public Health Agency of Canada and Mental Health Commission of Canada. Dr James Kirkbride is a Reader in Epidemiology in the Division of Psychiatry, UCL. He specialises in investigating the determinants of excess risk of schizophrenia and other psychotic disorders experienced by urban populations and ethnic minority groups. He runs the PsyLife group (www.PsyLife.eu) in the Division of Psychiatry, UCL.

Background: Being born in more urban, deprived and socially fragmented neighbourhoods is associated with increased schizophrenia risk. It remains unclear whether this association is causal, or arises due to genetic confounding, possibly via inter-generational social drift of those at greater schizophrenia risk over time. We investigated whether children with greater polygenic risk scores (PRS) for schizophrenia were more likely to be born in more disadvantaged neighbourhoods. Method: Using geocoded data from the Avon Longitudinal Study of Parents and Children, standardised PRS for schizophrenia and multinomial logistic regression models, we investigated the association between greater PRS and tertiles of neighbourhood population density, deprivation, inequality and social fragmentation at birth. Results: A total of 6,374 children had data available on neighbourhood characteristics at birth and PRS. A one standard deviation increase in PRS was associated with greater risk of being born in the most deprived neighbourhoods (third tertile relative risk ratio (RRR): 1.07, 95% confidence intervals (CI): 95%CI: 1.00 – 1.14, p=0.04) and in more socially fragmented neighbourhoods (second tertile RRR: 1.07, 95%CI: 1.01 – 1.14 p=0.02; third tertile: RRR: 1.12, 95% CI: 1.05 – 1.20, p<0.0001). We did not observe any other associations.Conclusions: In this population-based cohort of children in southwest England, those born in more deprived and socially fragmented, but not densely populated neighbourhoods were at greater polygenic risk for schizophrenia. These findings only partially support intergenerational drift as a possible explanation of higher schizophrenia rates in urban areas, and are in line with a multifactorial aetiology of schizophrenia.

BackgroundYoung adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk.MethodsIn a longitudinal UK population-based cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2,657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May-July 2020) when participants were aged 27-29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April-May 2020) moderated these associations.ResultsPre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing.ConclusionsYoung adults with pre-pandemic disordered eating, self-harm and comorbid disordered eating and self-harm are at increased risk for developing symptoms of depression, anxiety and poor mental wellbeing during the COVID-19 pandemic, even when accounting for pre-pandemic mental health. Lifestyle changes during the pandemic do not appear to alter this risk. A greater focus on rapid and responsive service provision is essential to reduce the impact of the pandemic on the mental health of these already vulnerable individuals.Plain English summaryThe aim of this project was to explore the mental health of young adults with disordered eating behaviours (such as fasting, vomiting/taking laxatives, binge-eating and excessive exercise) and self-harm during the COVID-19 pandemic. We analysed data from an established study that has followed children from birth (in 1991 and 1992) up to present day, including during the pandemic when participants were 28 years old. We looked at the relationship between disordered eating and/or self-harm behaviours from before the pandemic and mental health problems (symptoms of depression and anxiety) and mental wellbeing during the pandemic. We also explored whether there were any lifestyle changes (such as changes in sleep, exercise, visiting green space) that might be linked to better mental health and wellbeing in young adults with disordered eating and self-harm. We found that young adults with prior disordered eating and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing than individuals without prior disordered eating or self-harm. However, lifestyle changes did not appear to affect mental health and wellbeing in these young adults. Our findings suggest that people with a history of disordered eating and/or self-harm are at high risk for developing mental health problems during the pandemic, and they will need help from mental health services.

Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Purpose Evidence suggests that the harm avoidance personality type is more common among individuals with night eating syndrome (NES) than in the general population. Evidence of associations with other personality traits is limited. The current study investigated the association between a range of personality traits and NES.Methods Cross-sectional data were used from women with bulimia nervosa or binge eating disorder referred for treatment in an outpatient psychotherapy trial. Regression analyses were used to test associations between personality traits (measured with the Temperament and Character Inventory-Revised) and NES symptoms (measured with the Night Eating Questionnaire), adjusting for potential confounding variables.Results The sample included 111 women. Low cooperativeness scores were associated with greater NES symptoms in the multivariable model (mean difference: -.10, 95% confidence intervals: -.20 to -.01, p = 0.033). There was weak evidence of associations between both high harm avoidance and low self-directedness personality traits and greater NES symptoms.Conclusions The finding that low cooperativeness was associated with greater NES symptoms is novel. Further research is needed to validate its presence in those with and without comorbid eating disorders and to examine the relative change in NES, eating disorder symptoms and personality scores in treatments focusing on cooperativeness.Level of evidence Level I (randomised controlled trial, CTB/04/08/139)

Background Antidepressants have been proposed to act via their influence on emotional processing. We investigated the effect of discontinuing maintenance antidepressant treatment on positive and negative self-referential recall and the association between self-referential recall and risk of relapse. Methods The ANTLER trial was a large (N = 478) pragmatic double-blind trial investigating the clinical effectiveness of long-term antidepressant treatment for preventing relapse in primary care patients. Participants were randomised to continue their maintenance antidepressants or discontinue via a taper to placebo. We analysed memory for positive and negative personality descriptors, assessed at baseline, 12- and 52-week follow-up. Results The recall task was completed by 437 participants. There was no evidence of an effect of discontinuation on self-referential recall at 12 [positive recall ratio 1.00, 95% CI (0.90–1.11), p = 0.93; negative recall ratio 1.00 (0.87–1.14), p = 0.87] or 52 weeks [positive recall ratio 1.03 (0.91–1.17), p = 0.62; negative recall ratio 1.00 (0.86–1.15), p = 0.96; ratios larger than one indicate higher recall in the discontinuation group], and no evidence of an association between recall at baseline or 12 weeks and later relapse [baseline, positive hazard ratio (HR) 1.02 (0.93–1.12), p = 0.74; negative HR 1.01 (0.90–1.13), p = 0.87; 12 weeks, positive HR 0.99 (0.89–1.09), p = 0.81; negative HR 0.98 (0.84–1.14), p = 0.78; ratios larger than one indicate a higher frequency of relapse in those with higher recall]. Conclusions We found no evidence that discontinuing long-term antidepressants altered self-referential recall or that self-referential recall was associated with risk of relapse. These findings suggest that self-referential recall is not a neuropsychological marker of antidepressant action.