Publications by category
Journal articles
Russell A (In Press). A process evaluation of a peer education project to improve mental health literacy in secondary school students: Study Protocol. BMC Public Health
Evans R, Parker R, Russell AE, Mathews F, Ford T, Hewitt G, Scourfield J, Janssens A (In Press). Adolescent self-harm prevention and intervention in secondary schools: a survey of staff in England and Wales. Child and Adolescent Mental Health
Russell A, Hemani G, Jones H, Ford T, Gunnell D, Heron J, Moran P, Joinson C, Relton C, Suderman M, et al (In Press). An Exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt. BMC Psychiatry
Russell A, May F, Ford T, Janssens A, Newlove-Delgado T, Salim J, Ukoumunne O, Hayes R (In Press). Attainment, attendance and school difficulties in UK primary school children with probable ADHD. British Journal of Educational Psychology
Russell A, Rajapakse T, Kidger J, Bandara P, López-López J, Senarathna L, Metcalfe C, Gunnell D, Knipe D (In Press). Childhood adversity and self-poisoning: a hospital case control study in Sri Lanka. PLoS One
Russell A, Joinson C, Roberts E, Heron J, Ford T, Gunnell D, Moran P, Relton C, Suderman M, Mars B, et al (In Press). Childhood adversity, pubertal timing and self-harm: a longitudinal cohort study. Psychological Medicine
Troy D, Russell A, Kidger J, Wright C (In Press). Childhood psychopathology mediates associations between childhood adversities and multiple health risk behaviours in adolescence: analysis using the ALSPAC birth cohort. Journal of Child Psychology and Psychiatry
Russell AE, Ford T, Moore D, Russell G, Tay M (In Press). Educational practitioners’ perceptions of ADHD. A qualitative study of views of the home lives of children with ADHD in the UK. British Journal of Special Education
Russell A, Mars B, Wen CP, Chang S-S, Gunnell D (In Press). Evidence for an association between inflammatory markers and suicide: a cohort study based on 359,849 to 462,747 Taiwanese adults. Journal of Affective Disorders
Orri M, Russell A, Mars B, Turecki G, Gunnell D, Heron J, Tremblay R, Boivin M, Nuyt A-M, Sylvana C, et al (In Press). Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: Longitudinal analyses from two 20-year birth cohort studies. Psychological Medicine
Perry R, Ford T, O'Mahen H, Russell A (In Press). Prioritising targets for school-based ADHD interventions: a Delphi survey. School Mental Health
Benham-Clarke S, Ford T, Mitchell S, Price A, Newlove-Delgado T, Blake S, Eke H, Moore D, Russell A, Janssens A, et al (In Press). Role of Education Settings in Transition from Child to Adult Health Services for Young People with ADHD. Journal of Emotional and Behavioural Difficulties
Russell A, Newlove-Delgado T, Russell G (In Press). The challenges and opportunities of mental health data sharing in the UK. The Lancet Digital Health
Russell AE, Curtin E, Widnall E, Dodd S, Limmer M, Simmonds R, Kidger J (2023). Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK.
Community Mental Health Journal,
59(4), 784-796.
Abstract:
Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK
AbstractMany mental health problems begin in adolescence and occur on a spectrum of severity: early recognition and intervention is important. This study is a quantitative feasibility study of the Mental Health Foundation’s Peer Education Project (PEP). Attrition, psychometric properties of questionnaires, indications of improvement on a range of outcomes, and sample size required for a powered trial of effectiveness were assessed. 203 students completed the survey both pre and post-intervention. It was found that existing previously-validated measures had good psychometric properties, with two new questionnaires demonstrating reasonable reliability (self-help confidence alpha = 0.78, mental health knowledge alpha = 0.59). There were indications of improvement in help-seeking intentions, the number of sources likely to seek help from, and mental health knowledge from pre- to post-intervention. A future trial of PEP with a sample of approximately 36 schools, researcher-led data collections, and help-seeking intentions or sources as a primary outcome appears to be feasible.
Abstract.
Russell AE, Dunn B, Hayes R, Moore D, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T (2023). Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study.
BMJ Open,
13(2), e065176-e065176.
Abstract:
Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study
IntroductionAttention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%–5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers’ preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital ‘toolkit’ of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions.Methods and analysisA randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16–32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility.Ethics and disseminationEthical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.
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Newlove‐Delgado T, Russell AE, Mathews F, Cross L, Bryant E, Gudka R, Ukoumunne OC, Ford TJ (2022). Annual Research Review: the impact of Covid‐19 on psychopathology in children and young people worldwide: systematic review of studies with pre‐ and within‐pandemic data. Journal of Child Psychology and Psychiatry, 64(4), 611-640.
Russell A, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T (2022). Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol.
Systematic Reviews,
11Abstract:
Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol
Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome.
Methods: a systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components.
Discussion: This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD.
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Pavlickova H, Russell AE, Lightman S, McCabe R (2021). Feasibility of salivary cortisol collection in patients and companions attending dementia diagnostic meetings in memory clinics.
BMC Research Notes,
14(1).
Abstract:
Feasibility of salivary cortisol collection in patients and companions attending dementia diagnostic meetings in memory clinics
Abstract
. Objectives
. Receiving a diagnosis of dementia is life-changing for the individual and their companion. The aim of the study was to explore the feasibility of collecting salivary cortisol from patients who are informed if they have dementia and their companions. Patients and companions collected nine saliva samples in three batches: 1–2 weeks before, immediately before, and immediately after the diagnostic meeting. Each batch consisted of three samples taken in the evening, after awaking and 30 mins post-waking.
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. Results
. 22.7% (N = 10) of 44 invited patients and nine companions agreed, with 18.2% patients (N = 8) and 15.9% companions (N = 7) providing samples. Participants found that saliva collection was demanding and disrupted routines. On a purely descriptive level, some indications of an increased cortisol stress response in patients diagnosed with dementia were found in this very small sample. Researchers should expect low recruitment rates in this elderly population. Simpler collection procedures, e.g. pre-labelled packages with date/time, possible omission of morning samples and objective rather than self-report assessment of waking and saliva collection times—using actigraphy wrist-watches bleeps to prompt people at the timepoints and electronic track caps—might improve adherence and improve the accuracy of timepoints when swabs were actually collected.
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Russell AE, Ford T, Gunnell D, Heron J, Joinson C, Moran P, Relton C, Suderman M, Hemani G, Mars B, et al (2020). Investigating evidence for a causal association between inflammation and self-harm: a multivariable Mendelian Randomisation study.
Brain, Behavior, and Immunity,
89, 43-50.
Abstract:
Investigating evidence for a causal association between inflammation and self-harm: a multivariable Mendelian Randomisation study
Background: the causal role of inflammatory markers on self-harm and suicidal risk has been studied using observational data, with conflicting results. Confounding and reverse causation can lead to bias, so we appraised question from a genetic perspective to protect against these biases. We measured associations between genetic liability for high levels of inflammatory markers Interleukin-6 (IL-6) and C-reactive protein (CRP) on self-harm, and conducted a secondary analysis restricted to self-harm with suicidal intent. Methods: We conducted two sample and multivariable Mendelian randomisation (MR) to assess the effects of IL-6 and CRP on self-harm utilising existing data and conducting new genome wide association studies to instrument IL-6 and CRP, and for the outcome of self-harm. Results: No single nucleotide polymorphisms (SNPs) reached genome-wide significance for self-harm, however 193 SNPs met suggestive significance levels (p < 5 × 10−6). We found no evidence of an association between our instruments for IL-6 and self-harm in the two-sample MR, however we found an inverse association between instruments for CRP and self-harm, indicating that higher levels of circulating CRP may protect against self-harm (inverse variance weighted OR 0.92, 95%CI 0.84, 1.01, p = 0.08; MR Egger OR 0.86, 95% CI 0.74, 1.00, p = 0.05). The direct effect estimate for IL-6 was slightly smaller in the multivariable MR than in the two sample MR, while the CRP effect estimates were consistent with the two sample MR (OR 0.92, SE 1.05, p = 0.09). Conclusions: Our findings are conflicting and indicate that IL-6 and CRP are not robust etiological markers of increased self-harm or suicide risk.
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Russell A, Ford T, Russell G (2019). Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Social Psychiatry and Psychiatric Epidemiology
Russell AE, Heron J, Gunnell D, Ford T, Hemani G, Joinson C, Moran P, Relton C, Suderman M, Mars B, et al (2019). Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children.
J Child Psychol Psychiatry,
60(10), 1094-1103.
Abstract:
Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children.
BACKGROUND: Adverse childhood experiences (ACEs) such as physical and emotional abuse are strongly associated with self-harm, but mechanisms underlying this relationship are unclear. Inflammation has been linked to both the experience of ACEs and self-harm or suicide in prior research. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self-harm. METHODS: Participants were 4,308 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the United Kingdom. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0 and 9 years old (yo), levels of the inflammatory markers interleukin-6 and C-reactive protein measured at 9.5 yo, and self-harm reported at 16 yo. RESULTS: the mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self-harm at 16 yo (direct effect relative risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p
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Ford T, Hayes RA, Edwards V, Logan GS, Norwich B, Allen KL, Hansford L, Longdon BM, Norman S, Price A, et al (2019). Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT. Public Health Research, 7
Psychogiou L, Kallitsoglou A, Dimatis K, Parry E, Russell AE, Yilmaz M, Kuyken W, Moberly NJ (2018). Children's emotion understanding in relation to attachment to mother and father. British Journal of Developmental Psychology
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). Context and Implications Document for: School-based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods. Review of Education, 6
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods. Review of Education, 6
Psychogiou L, Moberly N, Parry E, Russell A, Nath S, Kallitsoglou A (2017). Does fathers’ and mothers’ rumination predict emotional symptoms in their children?. British Journal of Clinical Psychology, 56, 431-442.
Moore DA, Russell AE, Arnell S, Ford TJ (2017). Educators' experiences of managing students with ADHD: a qualitative study.
Child: Care, Health and Development,
43(4), 489-498.
Abstract:
Educators' experiences of managing students with ADHD: a qualitative study
Background: the symptoms of attention-deficit/hyperactivity disorder are associated with difficulty coping with the social, behavioural and academic components of school. Compared with medication and other non-pharmacological treatment, there is less evidence relating to school-based interventions to support children with ADHD. There is additionally an absence of any research focused on the experiences and practices of educators in the UK around how they work with children who are inattentive, impulsive and hyperactive. Methods: Forty-two educational practitioners from primary, secondary and alternate provision schools in the UK participated in focus groups or individual interviews that explored (1) their experiences of managing students with ADHD in the classroom and (2) factors that helped and hindered them in this endeavour. Transcripts were analysed using thematic analysis. Results: Analysis identified six themes: broad strategies, student-centred, inclusive strategies, labelling, medication and relationships. Participants' experiences of managing students with ADHD drew upon a wide range of strategies that typically involved responding to individual needs in an inclusive manner, so individuals with ADHD could access the classroom with their peers. Participants spoke about three factors that helped and hindered managing students with ADHD. Labelling of students with ADHD was reported, with the negative aspects of labelling, such as stigmatization, affecting the classroom. Educators reported mixed experiences regarding the helpfulness of medication; where helpful, it allowed the use of strategies in the classroom. Although students with ADHD were described as having rollercoaster relationships, positive relationships were considered key to the support of children with these difficulties. Conclusions: This study suggests that factors such as attitudes towards ADHD, relationships experienced by students with ADHD and other treatments being delivered need to be carefully considered before strategies are put in place in the classroom. This study supports the need for further work on the implementation of evidence-based school interventions for ADHD.
Abstract.
Ford T, Macdiarmid F, Russell AE, Racey D, Goodman R (2017). The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004.
Psychol Med,
47(6), 1126-1137.
Abstract:
The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004.
BACKGROUND: the identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare. METHOD: This secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression. RESULTS: Approximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores. CONCLUSIONS: Homotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions.
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Ford TJ, Russell AE, Russell G (2017). The relationship between fnancial difficulty and childhood symptoms of attention deficit/hyperactivity disorder: a UK longitudinal cohort study. Social Psychiatry and Psychiatric Epidemiology, 9
Gwernan-Jones RC, Moore DA, Cooper P, Russell AE, Richardson M, Rogers M, Thompson Coon J, Stein K, Ford T, Garside R, et al (2016). A Systematic Review and Synthesis of Qualitative Research: the Influence of School Context on Symptoms of Attention Deficit Hyperactivity Disorder.
Emotional and Behavioural Difficulties,
21(1), 83-100.
Abstract:
A Systematic Review and Synthesis of Qualitative Research: the Influence of School Context on Symptoms of Attention Deficit Hyperactivity Disorder
This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for Attention Deficit Hyperactivity Disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil's family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention.
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Richards DA, Bower P, Chew-Graham C, Gask L, Lovell K, Cape J, Pilling S, Araya R, Kessler D, Barkham M, et al (2016). Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.
Health Technol Assess,
20(14), 1-192.
Abstract:
Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.
BACKGROUND: Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. OBJECTIVE: to determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. DESIGN: Cluster randomised controlled trial. SETTING: UK primary care practices (n = 51) in three UK primary care districts. PARTICIPANTS: a total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. INTERVENTIONS: Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. MAIN OUTCOME MEASURES: Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. RESULTS: in total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI -0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI -£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator. CONCLUSIONS: Collaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se. TRIAL REGISTRATION: Current Controlled Trials ISRCTN32829227. FUNDING: This project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.
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Russell AE, Moore DA, Ford T (2016). Educational practitioners’ beliefs and conceptualisation about the cause of ADHD: a qualitative study.
Emotional and Behavioural Difficulties, 1-18.
Abstract:
Educational practitioners’ beliefs and conceptualisation about the cause of ADHD: a qualitative study
© 2016 SEBDA Objectives: Educational practitioners play an important role in the referral and treatment of children with attention-deficit/hyperactivity disorder (ADHD). This study aimed to explore how educational practitioners conceptualise their beliefs about the causes of symptoms of ADHD. Method: Forty-one educational practitioners from schools in the United Kingdom participated in focus groups or individual interviews. Data were analysed using thematic analysis. Results: Practitioners’ beliefs fell into two categories: biological and environmental. Practitioners conceptualised the causes of ADHD in lay-theoretical models: a ‘True’ ADHD model considered that symptoms of ADHD in many cases were due to adverse environments; and a model whereby a biological predisposition is the root of the cause of the child’s symptoms. Conclusion: Differential beliefs about the causes of ADHD may lead to practitioners blaming parents for a child’s behaviour and discounting ADHD as a valid condition. This has implications for the effective support of children with ADHD in schools.
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Russell AE, Ford T, Williams R, Russell G (2016). The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): a Systematic Review.
Child Psychiatry Hum Dev,
47(3), 440-458.
Abstract:
The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): a Systematic Review.
This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.
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Russell AE, Ford T, Russell G (2015). Socioeconomic Associations with ADHD: Findings from a Mediation Analysis.
PLoS One,
10(6).
Abstract:
Socioeconomic Associations with ADHD: Findings from a Mediation Analysis.
BACKGROUND: Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear. AIMS: the current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK. METHODS: Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association. RESULTS: Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association. CONCLUSIONS: Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.
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Chapters
Russell A (2022). Neurodevelopmental Disorders and Attendance at School. In Finning K, Ford T, Moore D (Eds.) Mental Health and Attendance at School, Cambridge: Cambridge University Press.
Publications by year
In Press
Russell A (In Press). A process evaluation of a peer education project to improve mental health literacy in secondary school students: Study Protocol. BMC Public Health
Evans R, Parker R, Russell AE, Mathews F, Ford T, Hewitt G, Scourfield J, Janssens A (In Press). Adolescent self-harm prevention and intervention in secondary schools: a survey of staff in England and Wales. Child and Adolescent Mental Health
Russell A, Hemani G, Jones H, Ford T, Gunnell D, Heron J, Moran P, Joinson C, Relton C, Suderman M, et al (In Press). An Exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt. BMC Psychiatry
Russell A, May F, Ford T, Janssens A, Newlove-Delgado T, Salim J, Ukoumunne O, Hayes R (In Press). Attainment, attendance and school difficulties in UK primary school children with probable ADHD. British Journal of Educational Psychology
Russell A, Rajapakse T, Kidger J, Bandara P, López-López J, Senarathna L, Metcalfe C, Gunnell D, Knipe D (In Press). Childhood adversity and self-poisoning: a hospital case control study in Sri Lanka. PLoS One
Russell A, Joinson C, Roberts E, Heron J, Ford T, Gunnell D, Moran P, Relton C, Suderman M, Mars B, et al (In Press). Childhood adversity, pubertal timing and self-harm: a longitudinal cohort study. Psychological Medicine
Troy D, Russell A, Kidger J, Wright C (In Press). Childhood psychopathology mediates associations between childhood adversities and multiple health risk behaviours in adolescence: analysis using the ALSPAC birth cohort. Journal of Child Psychology and Psychiatry
Russell AE, Ford T, Moore D, Russell G, Tay M (In Press). Educational practitioners’ perceptions of ADHD. A qualitative study of views of the home lives of children with ADHD in the UK. British Journal of Special Education
Russell A, Mars B, Wen CP, Chang S-S, Gunnell D (In Press). Evidence for an association between inflammatory markers and suicide: a cohort study based on 359,849 to 462,747 Taiwanese adults. Journal of Affective Disorders
Orri M, Russell A, Mars B, Turecki G, Gunnell D, Heron J, Tremblay R, Boivin M, Nuyt A-M, Sylvana C, et al (In Press). Perinatal adversity profiles and suicide attempt in adolescence and young adulthood: Longitudinal analyses from two 20-year birth cohort studies. Psychological Medicine
Perry R, Ford T, O'Mahen H, Russell A (In Press). Prioritising targets for school-based ADHD interventions: a Delphi survey. School Mental Health
Benham-Clarke S, Ford T, Mitchell S, Price A, Newlove-Delgado T, Blake S, Eke H, Moore D, Russell A, Janssens A, et al (In Press). Role of Education Settings in Transition from Child to Adult Health Services for Young People with ADHD. Journal of Emotional and Behavioural Difficulties
Russell A, Newlove-Delgado T, Russell G (In Press). The challenges and opportunities of mental health data sharing in the UK. The Lancet Digital Health
2023
Russell AE, Curtin E, Widnall E, Dodd S, Limmer M, Simmonds R, Kidger J (2023). Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK.
Community Mental Health Journal,
59(4), 784-796.
Abstract:
Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK
AbstractMany mental health problems begin in adolescence and occur on a spectrum of severity: early recognition and intervention is important. This study is a quantitative feasibility study of the Mental Health Foundation’s Peer Education Project (PEP). Attrition, psychometric properties of questionnaires, indications of improvement on a range of outcomes, and sample size required for a powered trial of effectiveness were assessed. 203 students completed the survey both pre and post-intervention. It was found that existing previously-validated measures had good psychometric properties, with two new questionnaires demonstrating reasonable reliability (self-help confidence alpha = 0.78, mental health knowledge alpha = 0.59). There were indications of improvement in help-seeking intentions, the number of sources likely to seek help from, and mental health knowledge from pre- to post-intervention. A future trial of PEP with a sample of approximately 36 schools, researcher-led data collections, and help-seeking intentions or sources as a primary outcome appears to be feasible.
Abstract.
Russell AE, Dunn B, Hayes R, Moore D, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T (2023). Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study.
BMJ Open,
13(2), e065176-e065176.
Abstract:
Investigation of the feasibility and acceptability of a school-based intervention for children with traits of ADHD: protocol for an iterative case-series study
IntroductionAttention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%–5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers’ preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital ‘toolkit’ of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions.Methods and analysisA randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16–32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility.Ethics and disseminationEthical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.
Abstract.
2022
Newlove‐Delgado T, Russell AE, Mathews F, Cross L, Bryant E, Gudka R, Ukoumunne OC, Ford TJ (2022). Annual Research Review: the impact of Covid‐19 on psychopathology in children and young people worldwide: systematic review of studies with pre‐ and within‐pandemic data. Journal of Child Psychology and Psychiatry, 64(4), 611-640.
Russell A (2022). Neurodevelopmental Disorders and Attendance at School. In Finning K, Ford T, Moore D (Eds.) Mental Health and Attendance at School, Cambridge: Cambridge University Press.
Russell A, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T (2022). Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol.
Systematic Reviews,
11Abstract:
Synthesising the existing evidence for nonpharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol
Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome.
Methods: a systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components.
Discussion: This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD.
Abstract.
2021
Pavlickova H, Russell AE, Lightman S, McCabe R (2021). Feasibility of salivary cortisol collection in patients and companions attending dementia diagnostic meetings in memory clinics.
BMC Research Notes,
14(1).
Abstract:
Feasibility of salivary cortisol collection in patients and companions attending dementia diagnostic meetings in memory clinics
Abstract
. Objectives
. Receiving a diagnosis of dementia is life-changing for the individual and their companion. The aim of the study was to explore the feasibility of collecting salivary cortisol from patients who are informed if they have dementia and their companions. Patients and companions collected nine saliva samples in three batches: 1–2 weeks before, immediately before, and immediately after the diagnostic meeting. Each batch consisted of three samples taken in the evening, after awaking and 30 mins post-waking.
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. Results
. 22.7% (N = 10) of 44 invited patients and nine companions agreed, with 18.2% patients (N = 8) and 15.9% companions (N = 7) providing samples. Participants found that saliva collection was demanding and disrupted routines. On a purely descriptive level, some indications of an increased cortisol stress response in patients diagnosed with dementia were found in this very small sample. Researchers should expect low recruitment rates in this elderly population. Simpler collection procedures, e.g. pre-labelled packages with date/time, possible omission of morning samples and objective rather than self-report assessment of waking and saliva collection times—using actigraphy wrist-watches bleeps to prompt people at the timepoints and electronic track caps—might improve adherence and improve the accuracy of timepoints when swabs were actually collected.
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Abstract.
Russell A, Ford T, McIntosh A, Jones PB, Shenow S, Russell G, McManus S (2021). Researcher access to mental health data: results from an online consultation.
Abstract:
Researcher access to mental health data: results from an online consultation
Many scientists and researchers use information from hundreds or thousands of people to understand more about health and wellbeing, and to improve treatments and support for those with health problems. This information, or data, is collected in many ways and is kept secure by organisations or individuals known as ‘data controllers’. Their job is to manage the processes that allow bona fide researchers access to these data in a way that respects the privacy and confidentiality of the people the data refers to.
Since the new data protection regulations (GDPR) introduced in the UK in 2018, we have heard that researchers and scientists are finding it more difficult to access the health data they need to do important scientific research. In order to collect more information about whether people are having problems with accessing data, and to understand more about what problems people were having, we conducted a short online consultation or survey asking about data access.
We advertised the consultation by saying that MQ Mental Health Research (a charity that aims to improve mental health via research) and NHS Digital were interested in hearing about how the data access process could be improved, so it is possible that participants tended to be those who had faced difficulties. Sixty-three people took part in the survey, which was available for just over one month in late 2019. Eleven of them had not yet tried to get access to data, but said they were expecting problems if they were to try. Sixteen people were currently trying to access data, and 36 had successfully accessed data.
The 52 people who had tried to, or had accessed, data reported a wide range of problems with their applications. Often each person experienced multiple problems. The application process has lasted between 2 and 70 months (median 12 months), bearing in mind that some of these were not yet completed. There were two common issues. Firstly, the process of application was lengthy and complicated, and not clearly explained. Secondly, researchers reported getting different advice from different people within the same organisation on the same procedures. In addition, some people reported difficulty finding a person who was senior enough in their own institution to sign off the forms.
Our recommendations for data controllers, research organisations, and individual researchers following this consultation are shown in Box 1. Our consultation suggests that data access processes need to be clearer and more streamlined and applied in the same way across different data controllers. This would help to ensure that people seeking to access data get consistent advice and consistent responses. We recommend that timelines for the application process, as well as the time between application approval and data provision, are shortened. We need a better balance between data security and privacy on the one hand, and the availability of data to provide evidence for policy and practice in line with the open science movement on the other. This is particularly true where research stands to directly benefit individuals or societies. Those we consulted had a lot of suggestions for specific amendments
4
to parts of the existing process, which were underpinned by frustration and confusion with the process as a whole. Our findings highlight the need for rapid improvement and we recommend actions for all stakeholders within the next 12 months. Given that many other countries routinely publish studies using recent epidemiological data, failure to improve data access processes will clearly result in the UK lagging behind in the international scientific field.
Abstract.
2020
Russell AE, Ford T, Gunnell D, Heron J, Joinson C, Moran P, Relton C, Suderman M, Hemani G, Mars B, et al (2020). Investigating evidence for a causal association between inflammation and self-harm: a multivariable Mendelian Randomisation study.
Brain, Behavior, and Immunity,
89, 43-50.
Abstract:
Investigating evidence for a causal association between inflammation and self-harm: a multivariable Mendelian Randomisation study
Background: the causal role of inflammatory markers on self-harm and suicidal risk has been studied using observational data, with conflicting results. Confounding and reverse causation can lead to bias, so we appraised question from a genetic perspective to protect against these biases. We measured associations between genetic liability for high levels of inflammatory markers Interleukin-6 (IL-6) and C-reactive protein (CRP) on self-harm, and conducted a secondary analysis restricted to self-harm with suicidal intent. Methods: We conducted two sample and multivariable Mendelian randomisation (MR) to assess the effects of IL-6 and CRP on self-harm utilising existing data and conducting new genome wide association studies to instrument IL-6 and CRP, and for the outcome of self-harm. Results: No single nucleotide polymorphisms (SNPs) reached genome-wide significance for self-harm, however 193 SNPs met suggestive significance levels (p < 5 × 10−6). We found no evidence of an association between our instruments for IL-6 and self-harm in the two-sample MR, however we found an inverse association between instruments for CRP and self-harm, indicating that higher levels of circulating CRP may protect against self-harm (inverse variance weighted OR 0.92, 95%CI 0.84, 1.01, p = 0.08; MR Egger OR 0.86, 95% CI 0.74, 1.00, p = 0.05). The direct effect estimate for IL-6 was slightly smaller in the multivariable MR than in the two sample MR, while the CRP effect estimates were consistent with the two sample MR (OR 0.92, SE 1.05, p = 0.09). Conclusions: Our findings are conflicting and indicate that IL-6 and CRP are not robust etiological markers of increased self-harm or suicide risk.
Abstract.
Russell A (2020). Prioritising targets for school-based ADHD interventions: a Delphi survey. Survey data.
2019
Russell A, Ford T, Russell G (2019). Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Social Psychiatry and Psychiatric Epidemiology
Russell AE, Heron J, Gunnell D, Ford T, Hemani G, Joinson C, Moran P, Relton C, Suderman M, Mars B, et al (2019). Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children.
J Child Psychol Psychiatry,
60(10), 1094-1103.
Abstract:
Pathways between early-life adversity and adolescent self-harm: the mediating role of inflammation in the Avon Longitudinal Study of Parents and Children.
BACKGROUND: Adverse childhood experiences (ACEs) such as physical and emotional abuse are strongly associated with self-harm, but mechanisms underlying this relationship are unclear. Inflammation has been linked to both the experience of ACEs and self-harm or suicide in prior research. This is the first study to examine whether inflammatory markers mediate the association between exposure to ACEs and self-harm. METHODS: Participants were 4,308 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the United Kingdom. A structural equation modelling approach was used to fit a mediation model with the number of ACEs experienced between ages 0 and 9 years old (yo), levels of the inflammatory markers interleukin-6 and C-reactive protein measured at 9.5 yo, and self-harm reported at 16 yo. RESULTS: the mean number of ACEs young people experienced was 1.41 (SE 0.03). Higher ACE scores were associated with an increased risk of self-harm at 16 yo (direct effect relative risk (RR) per additional ACE 1.11, 95% CI 1.05, 1.18, p
Abstract.
Author URL.
Ford T, Hayes RA, Edwards V, Logan GS, Norwich B, Allen KL, Hansford L, Longdon BM, Norman S, Price A, et al (2019). Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT. Public Health Research, 7
2018
Psychogiou L, Kallitsoglou A, Dimatis K, Parry E, Russell AE, Yilmaz M, Kuyken W, Moberly NJ (2018). Children's emotion understanding in relation to attachment to mother and father. British Journal of Developmental Psychology
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). Context and Implications Document for: School-based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods. Review of Education, 6
Moore D, Russell A, Matthews J, Ford T, Rogers M, Ukoumunne O, Kneale D, Thompson Coon J, Sutcliffe K, Nunns M, et al (2018). School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods. Review of Education, 6
2017
Psychogiou L, Moberly N, Parry E, Russell A, Nath S, Kallitsoglou A (2017). Does fathers’ and mothers’ rumination predict emotional symptoms in their children?. British Journal of Clinical Psychology, 56, 431-442.
Moore DA, Russell AE, Arnell S, Ford TJ (2017). Educators' experiences of managing students with ADHD: a qualitative study.
Child: Care, Health and Development,
43(4), 489-498.
Abstract:
Educators' experiences of managing students with ADHD: a qualitative study
Background: the symptoms of attention-deficit/hyperactivity disorder are associated with difficulty coping with the social, behavioural and academic components of school. Compared with medication and other non-pharmacological treatment, there is less evidence relating to school-based interventions to support children with ADHD. There is additionally an absence of any research focused on the experiences and practices of educators in the UK around how they work with children who are inattentive, impulsive and hyperactive. Methods: Forty-two educational practitioners from primary, secondary and alternate provision schools in the UK participated in focus groups or individual interviews that explored (1) their experiences of managing students with ADHD in the classroom and (2) factors that helped and hindered them in this endeavour. Transcripts were analysed using thematic analysis. Results: Analysis identified six themes: broad strategies, student-centred, inclusive strategies, labelling, medication and relationships. Participants' experiences of managing students with ADHD drew upon a wide range of strategies that typically involved responding to individual needs in an inclusive manner, so individuals with ADHD could access the classroom with their peers. Participants spoke about three factors that helped and hindered managing students with ADHD. Labelling of students with ADHD was reported, with the negative aspects of labelling, such as stigmatization, affecting the classroom. Educators reported mixed experiences regarding the helpfulness of medication; where helpful, it allowed the use of strategies in the classroom. Although students with ADHD were described as having rollercoaster relationships, positive relationships were considered key to the support of children with these difficulties. Conclusions: This study suggests that factors such as attitudes towards ADHD, relationships experienced by students with ADHD and other treatments being delivered need to be carefully considered before strategies are put in place in the classroom. This study supports the need for further work on the implementation of evidence-based school interventions for ADHD.
Abstract.
Ford T, Macdiarmid F, Russell AE, Racey D, Goodman R (2017). The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004.
Psychol Med,
47(6), 1126-1137.
Abstract:
The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004.
BACKGROUND: the identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare. METHOD: This secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression. RESULTS: Approximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores. CONCLUSIONS: Homotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions.
Abstract.
Author URL.
Ford TJ, Russell AE, Russell G (2017). The relationship between fnancial difficulty and childhood symptoms of attention deficit/hyperactivity disorder: a UK longitudinal cohort study. Social Psychiatry and Psychiatric Epidemiology, 9
2016
Gwernan-Jones RC, Moore DA, Cooper P, Russell AE, Richardson M, Rogers M, Thompson Coon J, Stein K, Ford T, Garside R, et al (2016). A Systematic Review and Synthesis of Qualitative Research: the Influence of School Context on Symptoms of Attention Deficit Hyperactivity Disorder.
Emotional and Behavioural Difficulties,
21(1), 83-100.
Abstract:
A Systematic Review and Synthesis of Qualitative Research: the Influence of School Context on Symptoms of Attention Deficit Hyperactivity Disorder
This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for Attention Deficit Hyperactivity Disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil's family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention.
Abstract.
Richards DA, Bower P, Chew-Graham C, Gask L, Lovell K, Cape J, Pilling S, Araya R, Kessler D, Barkham M, et al (2016). Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.
Health Technol Assess,
20(14), 1-192.
Abstract:
Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial.
BACKGROUND: Collaborative care is effective for depression management in the USA. There is little UK evidence on its clinical effectiveness and cost-effectiveness. OBJECTIVE: to determine the clinical effectiveness and cost-effectiveness of collaborative care compared with usual care in the management of patients with moderate to severe depression. DESIGN: Cluster randomised controlled trial. SETTING: UK primary care practices (n = 51) in three UK primary care districts. PARTICIPANTS: a total of 581 adults aged ≥ 18 years in general practice with a current International Classification of Diseases, Tenth Edition depressive episode, excluding acutely suicidal people, those with psychosis, bipolar disorder or low mood associated with bereavement, those whose primary presentation was substance abuse and those receiving psychological treatment. INTERVENTIONS: Collaborative care: 14 weeks of 6-12 telephone contacts by care managers; mental health specialist supervision, including depression education, medication management, behavioural activation, relapse prevention and primary care liaison. Usual care was general practitioner standard practice. MAIN OUTCOME MEASURES: Blinded researchers collected depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety (General Anxiety Disorder-7) and quality of life (European Quality of Life-5 Dimensions three-level version), Short Form questionnaire-36 items) outcomes at 4, 12 and 36 months, satisfaction (Client Satisfaction Questionnaire-8) outcomes at 4 months and treatment and service use costs at 12 months. RESULTS: in total, 276 and 305 participants were randomised to collaborative care and usual care respectively. Collaborative care participants had a mean depression score that was 1.33 PHQ-9 points lower [n = 230; 95% confidence interval (CI) 0.35 to 2.31; p = 0.009] than that of participants in usual care at 4 months and 1.36 PHQ-9 points lower (n = 275; 95% CI 0.07 to 2.64; p = 0.04) at 12 months after adjustment for baseline depression (effect size 0.28, 95% CI 0.01 to 0.52; odds ratio for recovery 1.88, 95% CI 1.28 to 2.75; number needed to treat 6.5). Quality of mental health but not physical health was significantly better for collaborative care at 4 months but not at 12 months. There was no difference for anxiety. Participants receiving collaborative care were significantly more satisfied with treatment. Differences between groups had disappeared at 36 months. Collaborative care had a mean cost of £272.50 per participant with similar health and social care service use between collaborative care and usual care. Collaborative care offered a mean incremental gain of 0.02 (95% CI -0.02 to 0.06) quality-adjusted life-years (QALYs) over 12 months at a mean incremental cost of £270.72 (95% CI -£202.98 to £886.04) and had an estimated mean cost per QALY of £14,248, which is below current UK willingness-to-pay thresholds. Sensitivity analyses including informal care costs indicated that collaborative care is expected to be less costly and more effective. The amount of participant behavioural activation was the only effect mediator. CONCLUSIONS: Collaborative care improves depression up to 12 months after initiation of the intervention, is preferred by patients over usual care, offers health gains at a relatively low cost, is cost-effective compared with usual care and is mediated by patient activation. Supervision was by expert clinicians and of short duration and more intensive therapy may have improved outcomes. In addition, one participant requiring inpatient treatment incurred very significant costs and substantially inflated our cost per QALY estimate. Future work should test enhanced intervention content not collaborative care per se. TRIAL REGISTRATION: Current Controlled Trials ISRCTN32829227. FUNDING: This project was funded by the Medical Research Council (MRC) (G0701013) and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.
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Author URL.
Russell AE, Moore DA, Ford T (2016). Educational practitioners’ beliefs and conceptualisation about the cause of ADHD: a qualitative study.
Emotional and Behavioural Difficulties, 1-18.
Abstract:
Educational practitioners’ beliefs and conceptualisation about the cause of ADHD: a qualitative study
© 2016 SEBDA Objectives: Educational practitioners play an important role in the referral and treatment of children with attention-deficit/hyperactivity disorder (ADHD). This study aimed to explore how educational practitioners conceptualise their beliefs about the causes of symptoms of ADHD. Method: Forty-one educational practitioners from schools in the United Kingdom participated in focus groups or individual interviews. Data were analysed using thematic analysis. Results: Practitioners’ beliefs fell into two categories: biological and environmental. Practitioners conceptualised the causes of ADHD in lay-theoretical models: a ‘True’ ADHD model considered that symptoms of ADHD in many cases were due to adverse environments; and a model whereby a biological predisposition is the root of the cause of the child’s symptoms. Conclusion: Differential beliefs about the causes of ADHD may lead to practitioners blaming parents for a child’s behaviour and discounting ADHD as a valid condition. This has implications for the effective support of children with ADHD in schools.
Abstract.
Russell AE, Ford T, Williams R, Russell G (2016). The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): a Systematic Review.
Child Psychiatry Hum Dev,
47(3), 440-458.
Abstract:
The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): a Systematic Review.
This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.
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2015
Russell AE, Ford T, Russell G (2015). Socioeconomic Associations with ADHD: Findings from a Mediation Analysis.
PLoS One,
10(6).
Abstract:
Socioeconomic Associations with ADHD: Findings from a Mediation Analysis.
BACKGROUND: Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear. AIMS: the current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK. METHODS: Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association. RESULTS: Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association. CONCLUSIONS: Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.
Abstract.
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