NIHRDataInsights/HRCSData huggingface dataset:
Title: Understanding the impacts of income and welfare policy responses to COVID-19 on inequalities in mental health: a microsimulation model
Funder: The Health Foundation

Abstract: During the COVID-19 pandemic, the UK government and devolved administrations are implementing policies to try and maintain employment and income. Despite this, many people have lost their jobs and more are likely to do so. Further policy changes will be needed as the pandemic continues. It is vital that these are informed by evidence about the impact they could have on people’s mental health, as unemployment and poverty are strongly associated with poorer health. This project will look at who is impacted the most by the job losses and declines in income, what the likely mental health consequences are of an economic crisis, and what the implications are of different economic and welfare policies. The project team will develop a mathematical model which will simulate the potential impact of economic changes on the mental health of people in Britain. Economic models will be used to estimate how the downturn will impact jobs and income, and information collected from the same people over many years will be used to study the relationship between jobs, income and mental health. The model will demonstrate how mental health might change under different economic policies (such as furlough or changes in welfare benefits), and the impact on mental health inequalities. The project will help inform the COVID-19 response by demonstrating the scale of the potential mental health crisis and how unemployment and income falls contribute, comparing the mental health impacts of different policies, and demonstrating how simulation models can be used to study the broader causes of poor health and inequalities.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH
Title: Causal effects of alcohol and mental health problems on employment outcomes: Harnessing UK Biobank and linked administrative data
Funder: The Health Foundation

Abstract: This project, led by the University of Glasgow, aims to improve understanding of the relationships between mental health problems and employment outcomes to establish the value of strategies to maintain good mental health for broader society. Mental health issues such as depression and alcohol-related problems are a major burden of illness in the UK. In contrast to many physical health problems, mental health conditions particularly affect the working age population, which in turn impacts on the UK economy. Mental health disorders are now the most common reason for receiving sickness and disability benefits and are linked to worklessness and adverse social outcomes. However, the causal relationship between them remains unclear. Studying the relationship between mental health and social outcomes is challenging because the causal effects are likely to operate in both directions; for example, employment may cause good mental health, and good mental health may make worklessness less likely. This project continues to use UK Biobank data to estimate the causal effects of alcohol consumption and depression on social outcomes, thereby identifying the long-term benefit of action to avoid the erosion of mental health and wellbeing. Work and Pensions Longitudinal Study data will be confidentially linked to Scottish health datasets to understand the loss of economic output because of the erosion of mental health status after the development of depression or alcohol-related problems. Two methodological approaches are being used: Mendelian randomisation (which uses genetic variants to test the causal effect of a risk factor on a health-related outcome), and regression analyses of linked health and welfare datasets. Qualitative methods are also being used to analyse policy discourse, key informant perspectives, and the lived experiences of people with mental health and alcohol problems. This work aims to provide an understanding of the potential societal benefits of maintaining and improving mental health and preventing and treating alcohol problems through investment in treatment and recovery services. Understanding the complex relationship and factors that impact individuals’ ability to sustain employment when facing mental health issues will enable government, employers, and individuals better to plan policies and interventions, and to self-manage conditions.


Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH
Title: Social disadvantage family support and young people's mental health in the UK
Funder: The Health Foundation

Abstract: Improving adolescent mental health is a major challenge for public policy. Those exposed to social adversity – including poverty, deprivation and associated risks such as parental mental illness and separation – are more likely to experience lifelong mental health issues. This not only impacts the young people themselves, but can also incur significant costs to society and care systems. Societal and family-level protective factors, including emotional and social support that promote resilience, can potentially mitigate some of these risks, but the evidence base on this so far is limited. This project by the University of Liverpool’s Health Inequalities Policy Research Group will investigate how social factors and adversities (eg poverty) interact to impact young people’s family relationships (eg parental involvement, parenting skills), the emotional family support they receive (eg care, safety) and their subsequent mental health. Innovative statistical approaches will be applied to understand these complex relationships over time, building on recent analyses of a large representative sample of children born between 2000 and 2002 (the UK Millennium Cohort Study) and the ongoing OveRcoming Adverse ChiLdhood Experiences project (ORACLE). Researchers will engage with young people aged 12 years and above, parents and other stakeholders (eg policymakers, practitioners, voluntary organisations, local authorities and the general public) through a series of online workshops and face-to-face meetings. Participants will have the opportunity to collaboratively shape insights and make recommendations on risk-reduction strategies for high-risk populations. The evidence generated will inform the development of more effective policies and interventions to improve family support and reduce inequalities in adolescent mental health in deprived cities across the UK, such as Liverpool.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH
Title: Understanding the determinants of mental health staff retention
Funder: The Health Foundation

Abstract: Mental health care has, on average, higher turnover of staff than the rest of the NHS – 13.6% of all mental health staff left in 2015/16, compared with 8.6% in acute NHS trusts. In the year to June 2017, one in eight of the sector’s workforce left the NHS, and one in 10 posts were vacant. The determinants of staff retention in mental health care are likely to be multi-factorial. For example, it may not be a violent incident that causes someone to consider leaving their job, but rather the response to that incident from colleagues and managers, and how that affects their perception of safety at work. This project will investigate variation in staff retention across the UK, in order to better identify and understand its determinants. The project team will explore the effects of organisational context, staff characteristics, roles, workplace practices and experiences at work in determining retention. They will also analyse how these factors are associated with patient outcomes. A review of the evidence on interventions to improve staff retention will be undertaken. Routinely collected data from mental health trusts about staff experiences, leaving rates, mental health service use by patients, and patient satisfaction will be examined, as well as the extent to which variation between trusts is explained by organisational context and trust-level staff turnover rates. These data will inform in-depth case studies, and the evidence will be brought together to identify good practice. Recommendations will then be made on how staff retention can be improved, and which interventions are effective.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH
Title: Efficiency cost and quality of mental healthcare provision
Funder: The Health Foundation

Abstract: Mental illness has a significant impact on individuals, society and the economy. However, there is limited understanding of how mental health care providers can use their limited resources to achieve the best outcomes for patients and taxpayers. This Efficiency Research project between the Universities of York, Sheffield and Birmingham looked at the efficiency, cost and quality of mental health care provision, and how changes can be made to deliver better care within available budgets.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH
Title: Critical Time Intervention for Severely Mentally Ill Released Prisoners: A Randomised Control Trial (CrISP)
Funder: Department of Health (England)

Abstract: Participants: 200 men with severe and enduring mental illness (SMI) released from prison. Setting: Three large local prisons.Design: Randomised controlled trial: CTI or TAU. Primary outcome measure: engagement with mental health services at six weeks post discharge;(cases equivalent time for controls);Secondary outcome measures will be engagement with mental health services at six and twelve months post intervention; number of days in hospital including detention under the Mental Health Act; CJS contacts and re-conviction rates comparing data from 12 months before the recent period of imprisonment with 12 months post-release using the Police National Computer (PNC). Community tenure will be calculated by adding days in hospital to days in prison. Power: Power calculated from feasibility study data. Taking into account the attrition rate in the feasibility trial 100 subjects in each arm (CTI and TAU) would give 90% power to detect a difference at the end of treatment (six weeks) of 50% in the treatment group vs. 25% in the control group (or greater) at the conventional 5% significance level.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH
Title: The detection and management of pain in patients with dementia in acute care settings: development of a decision tool
Funder: Department of Health (England)

Abstract: In 2007 the National Audit Office reported that 60% of hospital beds are occupied by older people of whom 40% may have dementia. To date there have been no studies in the United Kingdom exploring how pain is detected and managed in people with dementia on acute hospital wards. This study will address the following research questions:1. How are clinicians detecting managing and documenting pain in people with dementia in acute care settings?2. What is the clinical utility of existing tools to assist with the detection and management of pain in people with dementia in acute care settings?3. How acceptable and feasible would it be to introduce decision support tools into acute care settings?4. What is the role of carers in supporting the detection of pain in people with dementia in acute care settings?The MRC framework for the development and evaluation of complex interventions has been used to guide the study design. The study has three components:1. Two linked systematic reviews of existing evidence. The first will be a synthesis of existing systematic reviews of pain tools used with individuals with cognitive impairment. The second will be a review of pain assessment strategies used in acute care settings for use with people with dementia.2. A multiple case site study with embedded units of analysis (individual ward organisation). We will collect multiple sources of evidence including observation of practice interviews with clinical staff carers and managers and audits of policies and procedures to provide an in-depth analysis of current pain detection and management practices. This phase will explore how carers are currently included in the process and identify areas where it could be improved.3. Development of decision support tools and assessment of their acceptability in practice. On the basis of the findings from 1 and 2 decision support tools will be developed and iteratively evaluated in two stages. Focus groups will be used to refine tool development before they are implemented in hospital wards. Acceptability and feasibility will be assessed using observation of tool use interviews and documentary audit. We will include carers in the design and evaluation of the tools in this phase. The study will provide valuable insights into the challenges faced by clinical staff when assessing and managing pain in patients with dementia. It will produce decision support tools that have been initially tested for acceptability in acute care settings and guidance for carers and clinicians to support implementation of the research.


Research activity codes: 5.9 RESOURCES AND INFRASTRUCTURE (TREATMENT DEVELOPMENT)
Health categories: MENTAL HEALTH
Title: Cross-national comparative study of recovery-focused mental health care planning and coordination
Funder: Department of Health (England)

Abstract: Design: We propose to undertake a two-phase cross-national comparative study of recovery-focused mental health care planning and coordination. We will conduct a detailed comparative analysis of ostensibly similar approaches to recovery-focused CPA care planning and coordination within different government legislative policy and provider contexts.Phase 1: a) review of international literature on care planning and coordination processes and their relationships to recovery and personalisation; and b) comparative analysis of mental health policy and service frameworks in England and Wales. We will adopt Greenhalgh et al’s (2004) meta-narrative mapping technique (MNM) to provide a review of evidence that is most useful rigorous and relevant for service providers and decision-makers. Comparative analysis of policy and service frameworks will identify all key national-level policy and guidance documents relating to mental health care planning and coordination recovery and personalisation across the two countries. We will identify major themes and areas of policy convergence and divergence to describe ‘macro-level’ national policy contexts to inform our case study research interviews. Phase 2: We are employing a concurrent transformative mixed methods approach with embedded case studies (Creswell 2009: 215). We will conduct six in-depth meso-level case study investigations across contrasting case study sites in England (n=4) and Wales (n=2). Four NHS Trusts in England and two Local Health Boards in Wales are selected to reflect variety in geography and population and include a mix of rural urban and inner city settings in which routine community care is provided. Across the Trust/Board sites a large sample of service users (total n=400) and care coordinators (n=200) will be surveyed about recovery oriented practices therapeutic relationships and empowerment to develop a ‘Recovery profile’ of the organisation. Measures include the Recovery Self Assessment Scale (RSA) (O’Connell et al 2005); the Scale To Assess the Therapeutic Relationship (STAR) (McGuire-Snieckus et al 2007); and the Empowerment Scale (ES) (Rogers et al 1997). Documents and interviews with senior managers/practitioners will also be generated relating to local contexts policies and practices. In each site we will also select a single CMHT and invite a sample of service users (total n=36) to become the starting point for a series of embedded case studies nested within each meso-level organisational case study. Each service user their informal carers where possible (n=24) and their care coordinator (n=36) will be interviewed and CPA care plans will be reviewed. Analysis and interpretation of the case study data will be informed by a conceptual framework that emphasises the connections between different (macro/meso/micro) levels of policy and service organisation and that draws on the findings of the literature and policy review.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH
Title: The detection and prognosis of perinatal depression: a prospective validation of the National Institute for Health and Clinical Excellence (NICE)-endorsed ultra-brief questions
Funder: Department of Health (England)

Abstract: Our research objectives will be met using the following methods which build upon and enrich an existing epidemiological cohort of expectant/new mothers and babies (the Born And Bred in Yorkshire Study BABY) representing research synergy added value and value for money to the funder.OBJECTIVE ONE - INSTRUMENT VALIDATION: We will use a gold standard (WHO ICD-10) assessment of mood at two points (20 weeks pregnancy and 3-4 months post-birth). By cross-validating our gold standard against scores on the NICE-endorsed questions and the EPDS we will be able to calculate sensitivity specificity and likelihood (positive/negative) ratios with confidence intervals. Our study is powered to detect a clinically important range of sensitivity estimates.OBJECTIVE TWO - LONGITUDINAL ASSESSMENT: We will judge the temporal stability of positive and negative screens between pre- and post-birth and ascertain the persistence of early screens in predicting longer term problemsOBJECTIVE THREE - STANDARDISED DIAGNOSTIC ASSESSMENT OF CO-MORBIDITY: We will assess co-morbidity in two ways; using previously validated questionnaires and by using the WHO diagnostic gold standard structured interview to ascertain the presence of anxiety disorders and somatoform compliants (physical symptoms with a lower probability of physical pathology).OBJECTIVE FOUR - EVALUATION OF ACCEPTABILITY: We will use qualitative interviews and apply a specific technique (cognitive interviewing) to mothers and healthcare professionals to ascertain whether screening is acceptable and which questionnaire items are potentially problematic and the potential implications for the care pathway and training needs. OBJECTIVE FIVE - ESTIMATION OF COST EFFECTIVENESS: We have previously constructed a state of the art probabilistic decision model to estimate cost effectiveness of screening programmes in the NHS (9). We will upate this model on the basis of our research findings.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: MENTAL HEALTH
Title: Functional magnetic resonance imaging-based neurofeedback as a treatment method for depression
Funder: Division for Social Care and Health Research (Wales)

Abstract: Depression is the second most common illness in primary health care and disrupts the everyday functioning of over 100 million people worldwide. Depression is a severe mood disorder that is characterised by clinical features such as anhedonia (a loss of pleasure in previously enjoyable activities), cognitive and emotional impairment, psychomotor retardation, and disturbances in sleep and appetite. 20-40% of all patients do not benefit from traditional treatment methods such as psychotherapy or anti-depressant medication. This project will investigate a potential new treatment method: functional magnetic resonance imaging (fMRI)-based neurofeedback. In this method people undergo fMRI-scanning and receive continuously updated feedback about the activity level in a certain brain area, which they use to learn to control their own brain activity. It has previously been shown that chronic pain patients experienced considerably less pain after exercising control over a brain area involved in pain processing. In our project feedback from a region involved in positive emotion processing will be provided so that depressed patients can learn to regulate their emotional state. A pilot study of this method from our group has shown that depressed patients are both able to regulate their emotional network and experience significant improvements in mood.


Research activity codes: 6.5 RADIOTHERAPY AND OTHER NON-INVASIVE THERAPIES
Health categories: MENTAL HEALTH
Title: Randomised controlled trial of brief psychodynamic psychotherapy cognitive behaviour therapy and treatment as usual in adolescents with moderate to severe depression attending routine child and adolescent mental health clinics.
Funder: Department of Health (England)

Abstract: Major depression in adolescents is an important problem for the NHS. Around 1 in 10 referrals to child psychiatrists have significant depressive conditions. Clinical cases have many social and cognitive impairments and significantly increased risks of both attempted and completed suicide and a high rate of recurrence in adulthood. Indeed it seems that around 30% of adult affective disorders start in adolescence. A reduction in the duration and number of episodes in adolescence could therefore not only reduce short-term morbidity but also help to prevent depressive conditions and suicidal behaviour later in life. IMPACT (Improving Mood with Psychoanalytic and Cognitive Therapies) is a new clinical trial whose objective is to determine the most clinical and cost effective treatment that will reduce the risk of recurrence of clinical depression in young people. Our objectives are to compare three different types of psychological therapies in moderately to severely depressed adolescents attending CAMHS. We will randomise 540 (180 to each treatment arm) adolescents with unipolar major depression to one of three treatments : i) active clinical care lasting 12 weeks ii) cognitive behaviour therapy lasting 20 weeks iii) short term psychoanalytic therapy lasting 30 weeks. Cases in any arm may receive an antidepressant medication (fluoxetine is the medication of choice) if required according to the NICE guidelines. The patients will be reassessed up to and including 12 months after the end of treatment to determine the proportion of case who relapsed or showed persisting depressive symptoms and disorder. This is first trial in adolescents to investigate the best treatment to prevent relapse of this serious mental illness in young people that has devastating consequences on personal competence and well being through into adult life for more than a third of young sufferers.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH