Suchergebnisse

BackgroundLimited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need.MethodA systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings.ResultsExisting international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders.ConclusionMore research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.

Background Childhood adversity can include traumatic experiences and exposure to other risk factors; consistently predicting poorer psychosocial outcomes in adulthood. Relatively little research has investigated the impact of cumulative risk exposure in childhood. Using data collected in a specialist clinical setting, we investigated the associations between risk exposure, psychopathology and psychosocial functioning. Method Participants were children attending the Attachment and Trauma service at Great Ormond Street Hospital in London ( N = 132, M = 10.25, SD = 3.35). Data was collected via routine clinical practice during multi-disciplinary assessments. Data was collected on developmental and trauma history, psychopathology, and functioning (CGAS), using standardised measures, clinical interviews, and observations. Results All children had experienced at least one risk factor, with 78% reporting multiple exposures, including witnessing interpersonal violence (52%), neglect (48%), and physical abuse (42%). Other risk exposures included exposure to alcohol (17%) and substances (24%) in-utero, as well as social risk factors such as multiple foster placements in some cases. In this sample, 65% of children met criteria for at least one psychiatric diagnosis (Anxiety = 31%, PTSD = 28%, Depression = 8%). High levels of functional impairment were found, with 52% of children falling into the highest categories of 'obvious' or 'severe' problems. Multiple risk exposure significantly predicted PTSD (OR 9.64 (1.1, 83.7)), but did not predict anxiety, depression, or functional impairment. Conclusion This study highlights the rates of cumulative risk exposure in this clinical sample. The findings demonstrate the importance of detailed and accurate clinical assessments in ascertaining trauma histories in children with known histories of adversity and maltreatment. There are implications for assessment and treatment, such as the importance of clear guidelines on treating PTSD in children with complex trauma histories.

AbstractAs with the general population, people with intellectual disabilities are ageing, are living longer often with coexisting complex needs and with more requiring care and support. The focus of care is community‐based rather than institutional and it is therefore necessary to ensure that the workforce responsible for delivering care has the appropriate knowledge and skills to safely deliver the interventions required. The aim of this review is to evaluate the scope of invasive clinical interventions (ICIs) that social care support workers (SCSWs) are currently delivering and the preparation received to undertake these procedures or the knowledge held about the intervention. A search of educational, health, psychology, and social science databases was conducted, using a variety of combinations of search words to detect relevant literature. Only five studies published between 1999 and 2013 were identified and included in the review. The evidence shows that education can improve social carers' knowledge and when education is undertaken it needs to involve both a theoretical and practice‐related component. The current evidence is limited due to the small number of studies identified and the limitations of the study designs that were adopted. More research is required to identify whether ICIs currently being delivered by these SCSWs and the effectiveness and appropriateness of the education staff are receiving in relation to these.

Military veterans often encounter events with chronic or repeated traumas of an interpersonal nature that might lead to emotional, relational, and spiritual suffering. Research is needed to assess whether and/or how emerging conceptions of moral injury (MI) align with existing trauma-related conditions. Focusing on 173 veterans from the United Kingdom who had recently pursued mental health treatment, we examined associations between self- and other-directed outcomes related to MI and World Health Organization International Classifcation System for Diseases, 11th version (ICD-11) criteria for posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) in two ways. First, drawing on psychometrically validated tools for assessing MI (Currier et al., 2017) and PTSD/CPTSD (Cloitre et al., 2018), ANOVAs revealed the 57.2% of veterans in the sample who possibly met criteria for CPTSD reported greater MI related to both perpetration- and betrayal-based events compared to those with and without possible PTSD. Second, latent profile analysis revealed two distinct classes based on the symptom severity of MI and CPTSD. Specifically, when examining the six symptom clusters for CPTSD dimensionally, four in five of the veterans endorsed high levels of distress related to all indicators of MI and CPTSD symptoms compared to a group with consistently lower scores. Overall, the two sets of findings suggest the special relevance of MI among veterans who are struggling with CPTSD.

Purpose: Emerging evidence suggests that ICD-11 CPTSD is a more common condition than PTSD in treatment seeking samples although no study has explored risk factors and comorbidities of PTSD and CPTSD in veteran populations. In this study risk factors and comorbidity between veterans meeting criteria for PTSD or CPTSD using the ICD-11 International Trauma Questionnaire (ITQ) were explored. Methods: A sample of help-seeking veterans who had been diagnosed with a mental health difficulty (n=177) was recruited. Participants completed a range of mental health and functioning measures. Multinomial logistic regression analysis was conducted to explore differences in the above factors between participants meeting case criteria for PTSD, CPTSD or another mental health disorder. Results: Those with CPTSD appeared to have taken longer to seek help, reported higher rates of childhood adversity and more experiences of emotional or physical bullying during their military careers. Further, participants with CPTSD reported a greater burden of co-morbid mental health difficulties including high levels of dissociation, anger, difficulties related to moral injury and common mental health difficulties and greater degree of impairment including social isolation, sleep difficulties and impaired functioning. Conclusions: Considering that CPTSD is a more debilitating condition than PTSD, there is now an urgent need to test the effectiveness of new and existing interventions in veterans with CPTSD.

BackgroundThe research reported here sought to evaluate whether a dedicated education programme in vision awareness improved the knowledge and skills of autism support practitioners in identifying visual impairment in autistic people with intellectual disabilities and providing better support to those individuals identified as visually impaired.MethodsResearchers undertook a mixed methods evaluation. A survey questionnaire was devised and administered before and after training and focus groups were undertaken in order to gain qualitative data relating how practitioners implemented their learning in practice.ResultsKnowledge confidence and practice confidence scores of participants were significantly improved by the programme, which maintained its impact one year on. Practitioners reported increased access to optometry, changes to support practice and improvements to service environments as a result of the training.ConclusionAutism support practitioners' skills in identifying and supporting people with visual impairments were demonstrably enhanced through dedicated vision training.

Background: Veterans with PTSD typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and Complex PTSD (CPTSD) has not previously been explored in a military sample.Aim: This study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire (ITQ), and assess the rates of the disorder in a sample of treatment-seeking UK veterans.Method: A sample of help-seeking veterans (n=177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.Results: The majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.Conclusions: ITQ can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.

Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans were consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found, that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes.Method: Participants (N =1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence.Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes.Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seems to be groups of treatment-seeking military veterans that do not fulfill full criteria for a trauma-related disorder. ...

AbstractBackgroundTrauma and its sequelae is recognised as a major morbidity factor in people with intellectual disabilities, however, a lack of inquiry into how health care professionals address trauma in this adult population exists.AimsTo explore specialist intellectual disability practitioners perspectives on current health provision and developments to address trauma.MethodsTwenty‐five qualitative interviews were conducted with practitioners across 6 health service areas in the UK. Data were analysed using thematic content analysis.FindingsSeven central themes emerged: (a) unmasked trauma; (b) trauma informed care; (c) person‐centred care and support; (d) multi‐disciplinary working; (e) reasonable adjustments; (f) barriers to treatment and (g) awareness, training and education.ConclusionTrauma‐informed care and multi‐disciplinary working are essential components for future service development. Advances in the evidence‐base for effective psychological interventions for PTSD and training and education of health care staff are needed in order to improve service provision amongst this population.

AbstractObjectiveTo report the results of the first randomized feasibility trial of Eye Movement Desensitization and Reprocessing (EMDR) plus Standard Care (SC) versus SC alone for DSM‐5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities.MethodA total of 29 participants were randomized to either to EMDR + SC (n = 15) or SC (n = 14). Participants completed measures on traumatic stress (PCL‐C) and comorbid distress at baseline, 1 week post‐treatment and 3‐month follow‐up.ResultsIn the EMDR + SC group, 9 (60%) participants at post‐treatment and 7 (47%) participants at 3‐month follow‐up were diagnosis free. In SC, 4 (27%) at post‐treatment and follow‐up were diagnosis free. At post‐treatment, three participants (20%) dropped out from the EMDR + SC group, and 1 (7%) dropped out from the SC group.ConclusionsIt is feasible, acceptable and potentially effective to deliver EMDR in this population group.

Background: The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world. One such national education programme in the United Kingdom is the DESMOND Programme, which has been shown to be robust and effective for patients in general. However, these programmesare not generally targeted to people with intellectual disabilities (ID), and robust evidence on their effects for this population is lacking. We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID.This protocol is for a pilot trial to determine whether a large-scale randomised trial is feasible, to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes, in particular as a means to reduce glycated haemoglobin (Hb1Ac), improve psychological wellbeing and quality of life and promote a healthier lifestyle. This protocol describes the rationale, methods, proposed analysis plan and organisational and administrativedetails.Methods/Design: This trial is a two arm, individually randomised, pilot trial for adults with ID and type 2 diabetes, and their family and/or paid carers. It compares the DESMOND-ID programme with usual care. Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom. Family and/or paid carers may also participate in the study. Participants will be randomly assigned to one of two conditions using a secure computerised system with robust allocation concealment. A range of data will be collected from the adults with ID (biomedical,psychosocial and self-management strategies) and from their carers. Focus groups with all the participants will assess the acceptability of the intervention and the trial.Discussion: The lack of appropriate structured education programmes and educational materials for this population leads to secondary health conditions and may lead to premature deaths. There are significant ...