Dr Abby Dunn

Background: Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks.Objective: This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms.Methods: This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors.Results: Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022.Conclusions: The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety.Trial Registration: ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933International Registered Report Identifier (IRRID): DERR1-10.2196/40707

BackgroundMental health workers are subject to high levels of occupational stress which is associated with poorer health and wellbeing and impaired patient outcomes. For individuals operating in high stress environments, reducing challenge at home, in particular around parenting, has been found to generalize into improvements in the professional domain. The present study sought to investigate the effectiveness and feasibility of brief targeted workplace intervention to support workers in terms of their parental role. Design/MethodologyAn uncontrolled evaluation of a series of three-session parenting-focused courses delivered to employees of a large Mental Health Trust. A pre-post-follow-up design was used to investigate effects on outcomes including parenting practice and experience, wellbeing, stress, and occupational self-efficacy. Intervention feasibility and acceptably was also evaluated. FindingsData from 15 participants who completed measures pre-post indicates the courses were associated with improved parenting practice and experience at a p < 0.005 level. Improvements were reported at 6-month follow up. Participant satisfaction and course acceptability was highly rated by 100% of participants.

Objectives Ascertaining whether mental health service users have children is a clinical requirement in UK health services, and acknowledgement of a patient’s parenting role is necessary to enable engagement with their parenting experience and to facilitate support, both of which are associated with improved outcomes for the parent–child dyad. The current study sought to investigate the practice of mental health practitioners working in UK adult mental health services with regard to the following: Ascertaining whether patients have children; engagement with the parenting role of patients; engagement with the construct of ‘think patient as parent’. Methods Self‐report online/paper survey of 1105 multi‐disciplinary adult mental health practitioners working in 15 mental health trusts in England. Results A quarter of adult mental health practitioners did not routinely ascertain whether patients had dependent children. Less than half of practitioners engaged with the parenting experience or the potential impact of parental mental health on children. Conclusions The parenting role of patients is not routinely captured by large numbers of practitioners working in adult mental health settings. This is despite it being a mandatory requirement and an integral component of the systematic care of the adult, and preventative care for the offspring. Failure to engage with patients who are parents is a missed opportunity with profound downstream public health implications. The practice deficits identified in this study should be viewed in terms of broader structural failures to address the intergenerational transmission of poor mental health. Practitioner points Some parents who have mental health difficulties may struggle to provide appropriate and effective care to their children. The parenting role can also exacerbate mental health difficulties. Identification of dependent children is a mandatory component of adult mental health clinical practice and is necessary to understand a parent’s support needs. A quarter of adult mental health practitioners are failing to do so. A missed opportunity to engage with the support needs of the parent–child dyad.

Parent-report questionnaires are a common method of generating data on child outcomes in mental health studies. A second report from another person who knows the child (co-respondent) is implemented to reduce bias and increase objectivity. The success of this approach is dependent on the engagement of co-respondents, which can be difficult. Financial incentives are used to increase data return in clinical trials, and to promote referral rates in online marketing. This protocol describes the use of an embedded randomised controlled trial (RCT) to investigate the effect of financial incentives on rates of co-respondent data completion. In the host RCT (of an online intervention designed to reduce the impact of a parent's anxiety on their child) index participants (i.e. parents) are asked to invite a co-respondent to complete measures on the index child. This study will test the hypothesis that providing monetary incentives to index participants will increase the outcome measure completion rate of co-respondents. Embedded RCT of two parallel groups. Participants in the intervention arm will be sent a £10 voucher if their chosen co-respondent completes online baseline measures. Participants in the control arm will not be offered payment regardless of their chosen co-respondent's behaviour. 1754 participants will take part. Analysis will compare co-respondent outcome measure completion rates between the two arms at baseline and follow-up. Findings from this study will provide evidence on the impact of offering payment to index participants on return rates of co-respondent data. This will inform resource allocation within future clinical trials. •Clinical trials are dependent on effective data collection.•Incentives may improve measure completion rates.•Investigates effect of paying participants on outcome completion by co-respondents.

Quarter-life crisis (QLC) is a popular term for developmental crisis episodes that occur during early adulthood (18-30). Our aim was to explore what linguistic themes are associated with this phenomenon as discussed on social media. We analyzed 1.5 million tweets written by over 1,400 users from the United Kingdom and United States that referred to QLC, comparing their posts to those used by a control set of users who were matched by age, gender and period of activity. Logistic regression was used to uncover significant associations between words, topics, and sentiments of users and QLC, controlling for demographics. Users who refer to a QLC were found to post more about feeling mixed emotions, feeling stuck, wanting change, career, illness, school, and family. Their language tended to be focused on the future. Of 20 terms selected according to early adult crisis theory, 16 were mentioned by the QLC group more than the control group. The insights from this study could be used by clinicians and coaches to better understand the developmental challenges faced by young adults and how these are portrayed naturalistically in the language of social media.

Background Little is known about the experiences of parents who are in receipt of in-patient psychiatric care or about what interventions are employed to support them in their parenting role. Aims The objective of the current study is to review two complementary areas of research: (a) research examining interventions developed to support the parent-child relationship within these settings; and (b) research focused on the experience of parents in in-patient settings. Method For studies reporting on parents' experience, qualitative accounts of past or present psychiatric in-patients (child aged 1-18 years) were included. For intervention studies, the intervention had to focus on supporting the parenting role and/or the parent-child dyad of parents (child aged 1-18 years) in current receipt of in-patient care. Four bibliographic databases (PubMed, SCOPOS, Web of Science and PsychINFO) were searched for relevant published and unpublished literature from 1 January 1980 to 26 July 2022. Intervention studies were appraised using the Mixed Methods Appraisal Tool. Qualitative papers were assessed using the Critical Appraisal Skills Programme tool. Data were extracted using tools designed for the study. Qualitative data were synthesised using thematic analysis. The protocol was registered with the International Prospective Register of Systematic Reviews (reference CRD42022309065). Results Twenty-four papers (eight intervention studies and 16 studies examining parent experience) were included in the review. In-patient parents commonly reported hospital admission as having a negative impact on their parenting. Very few robust reports of interventions designed to support parents in receipt of psychiatric in-patient care were found. Conclusions Despite the identified need for support by parents who are receiving in-patient care, there is currently no intervention of this nature running in the UK health service.

Background Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful. Aim To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them. Methods Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison. Results Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents. Conclusion This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given.

Admiration is a social emotion that is developmentally formative in emerging adulthood; admired adults act as mentors, role models, and sources of inspiration to this age-group. The present study explored who and what emerging adults admire in their elders, across four countries (UK, Iran, China, and Russia). A total of 525 participants provided written descriptions of an admired figure. Across all cultures, care and generativity was the most common theme. Cross-cultural differences emerged for the themes of limitations and difficulties (most prevalent in China), autonomy and assertiveness (most prevalent in Russia), intellect and education (most prevalent in Russia), and religion and spirituality (most prevalent in Iran). Males and females in the UK and Russia tended to select admired figures of their own sex, but in Iran and China both male and female participants selected more male than female figures. The findings suggest a common thematic core to admiration in emerging adulthood combined with culturally specific features.

Children of anxious parents are at heightened risk of developing an anxiety disorder of their own, but promising research indicates that targeting parenting behaviours can reduce the risk of intergenerational transmission of anxiety. Given there is extensive evidence for the efficacy of treatments for adult anxiety, the current review sought to identify whether interventions solely addressing parental symptoms had any effect on the mental health and wellbeing of their children. Randomised Controlled Trials of psychological interventions targeting adults with a probable anxiety disorder and which included a child mental health or wellbeing outcome were eligible for inclusion. Scopus, Web of Science, PubMed, PsychINFO, and PsychArticles were searched, and 2137 articles were systematically reviewed. However, no articles were identified that met the review criteria. Research into interventions targeting adult anxiety is failing to consider the potential benefit treatment may have on dependent children. This is a missed opportunity to evaluate a potential means of support for children who are known to be at risk of anxiety. Evaluation of psychological interventions for adult anxiety should consider including both adult and child mental health outcomes to determine potential preventative effects.

Background: Parental psychosis (bipolar disorder and schizophrenia) are major risk factors for mental health problems in offspring. Although interventions that focus on parenting and the family environment have shown effectiveness in mitigating this risk, no systematic review has examined the impact of simply treating adult bipolar disorder or schizophrenia on their dependent children’s outcomes. Aims: To systematically review the effects (in randomized controlled trials) of adult-based interventions for bipolar disorder and schizophrenia, on offspring mental health and wellbeing. Method: Eligibility criteria included randomized controlled trials that examined the treatment of adults with bipolar disorder and schizophrenia that also included child mental health and wellbeing outcomes. PubMed, Scopus, PsycINFO, and PsychArticles databases were searched. Results: 168,317 studies were reviewed; however, zero studies that met the inclusion criteria could be found. Conclusions: The existing research aimed at treating adult bipolar disorder and schizophrenia has so far overlooked the potential advantages that these treatments could provide for their offspring. This is a missed opportunity to understand the mechanisms of intergenerational transmission. Researchers examining treatments for adults with bipolar disorder and schizophrenia should, where appropriate, consider including both adult and child mental health outcomes in their trials.

Background The use of a second informant (co-respondent) is a common method of identifying potential bias in outcome data (e.g., parent-report child outcomes). There is, however, limited evidence regarding methods of increasing response rates from co-respondents. The use of financial incentives is associated with higher levels of engagement and follow-up data collection in online surveys. This study investigated whether financial incentives paid to index participants in an online trial of a parenting-focused intervention, would lead to higher levels of co-respondent data collection. Methods A study within a trial (SWAT) using a parallel group RCT design. Participants in the host study (an RCT of an online intervention) were randomised into one of two SWAT arms: received/did not receive a £15 voucher when referred co-respondent completed baseline measures. Primary outcome was completion (No/Yes) of Spence Children's Anxiety Scale (SCAS or SCAS-Pre) at baseline. Additional analysis explored impact of incentives on data quality. Results Intention to treat analysis of 899 parents (183 co-respondents) in the no-incentive arm, and 911 parents (199 co-respondents) in incentive arm. Nomination of co-respondents was similar between incentive arms. The RR for the incentive arm compared to the no incentive arm was 1.13 (95% CI: 0.91 to 1.41, p = 0.264) indicating that incentives did not impact completion of outcomes by consented co-respondents. There were no indications of different data quality between arms. Discussion The finding that payment of financial incentives to index participant does not lead to greater levels of co-respondent outcome completion suggests that careful consideration should be made before allocating resources in this way in future trials.

Introduction When parents of dependent children are treated in psychiatric inpatient hospital, it typically involves separation of parent and child for the duration of treatment, which can be highly distressing to the dyad and can result in disruption to the parent-child relationship. Parents who have experienced hospitalisation have expressed a desire for their parenting identity to be recognized and appropriately engaged with during their treatment. This recognition includes provision of interventions which support them as parents to limit the impact of their mental health on their children. The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care.Methods The current study, the first of its kind known to have taken place, details a collaborative intervention development project for parents receiving inpatient care. This project involved the adaptation and extension of a prior parenting-focused course for parents high in anxiety to meet the needs of parents being treated in inpatient settings. In the first two stages of the three-phase project, patients, carers and mental health practitioners contributed to the revision and delivery plan for the course including developing new content for the intervention. In the final stage, which took the form of a participatory evaluation, the intervention was delivered to 11 parents receiving inpatient treatment who then provided extensive feedback. A series of iterative adaptations to the intervention were made in response to this feedback alongside stakeholder input.Results The final intervention comprises five modules focused on exploring the experience of parents alongside specific learning and skills orientated toward boosting their connection with their children during hospitalisation and in readiness for discharge. Preliminary feedback from patients and ward staff has been positive and the process of delivering the project on inpatient wards was associated with no increase in negative clinical outcomes.Discussion The successful development of a targeted intervention within inpatient psychiatric units offers a signal that parents treated in this setting welcome the opportunity to be supported in their parenting role. As the first known UK intervention of its kind to be developed in partnership with patients, ward staff and management, it is specifically tailored to the context and needs of this group with the potential to be delivered by a range of health professionals in this setting.

Children whose parents have anxiety problems are at increased risk of developing anxiety themselves. Parenting behaviors are a contributing factor to intergenerational transmission. Interventions which seek to limit anxiogenic parenting behaviors have shown potential in reducing anxiety in offspring but are not widely accessible. This prevention trial aimed to establish the effectiveness of an unguided modular online intervention for highly anxious parents in preventing anxiety in their children. A parallel group, block-randomised controlled trial of unblinded participants in a 1:1 ratio was conducted to compare efficacy of the online course compared to a no-intervention control. The intervention comprised 8 modules, of approximately 20 min each, and participants progressed through the course at their own pace. The study was conducted entirely online with a self-referred UK-based community sample of parents (child 2–11 years) with substantial anxiety. The primary outcome measure was change in parent-reported child anxiety, as measured by the Spence Children's Anxiety Scale–Parent Report (SCAS-P) or Spence Pre-School Anxiety Scale–Parent Report (Preschool SCAS). Secondary outcomes were child internalising, externalising, and attentional symptoms (Pediatric Symptom Checklist), and parent anxiety (SCARED-Adult). Analyses using complete case analysis following intention to treat principles investigated intervention effects at 6 months (primary analysis) and additionally at 9 to 25-months’ follow-up. Trial registration: ClinicalTrials.GovNCT04755933, https://clinicaltrials.gov/ct2/show/NCT04755933. 1811 participants (intervention = 900; control = 911; 92.7% (1677/1810) female; 85.3% (1535/1800) White-British; 66.8% (1201/1799) university educated). Participant retention (based on primary outcome completion) at T2 (6-months post consent) was 67.6% overall (n = 1224) and substantially lower in the intervention arm 57.3% ((516/900) control = 77.8% (708/910)). Child anxiety was lower in the intervention group compared to control at 6-month follow-up (adjusted effect size estimate −0.15 (95% CI: −0.23 to −0.08, p 

We desperately need more trials like the study by Cathy Creswell and colleagues: 1 a real-world effectiveness study, which showed the clear value of a digitally augmented intervention over the usual face-to-face treatment. Children who were referred to Child and Adolescent Mental Health Services (CAMHS) for treatment of anxiety did just as well when treated with therapist-supported, parent-led, online cognitive behavioural therapy (CBT) as those receiving the usual treatment offered by that setting, but they did so with just under 60% of the usual clinician time. The potential benefits to over-burdened services are clear.