North East London NHS Foundation Trust (NELFT) is an NHS foundation trust which provides mental and community health services. It runs Foxglove Ward, Goodmayes Hospital and Sunflowers Court in Ilford, Phoenix House in Basildon, Heronwood & Galleon Inpatient Facility in Wanstead, Grays Court Community Hospital in Dagenham, and Hawkwell Court in Chingford. Altogether it operates from more than 150 sites.
BACKGROUND:Ethnic inequalities exist in the prevalence of mental disorders and their associated treatment outcomes. Cultural variation may influence psychological symptom expression; understanding this might inform care and ultimately reduce care disparities. METHODS:Data were analysed from 147,037 individuals referred to psychological treatment services in London, England. Moderated network analysis was used to examine the expression and co-occurrence of symptoms of depression, anxiety, and social functioning. Age and gender were included as covariates, and ethnicity (11 categories) was entered as the moderating variable. Symptom-level differences and differences in symptom-to-symptom relationships were estimated across all ethnic group comparisons. RESULTS:There was substantial variation in symptom networks between ethnic groups. White British individuals showed the most differences compared to other ethnic groups, particularly with higher endorsement of anxiety-related symptoms (e.g. nervousness and excessive worry) and greater reported functional impairment in work and social domains. Differences in symptom co-occurrence (the relationships between symptoms) were less frequent than differences in individual symptom levels. Across groups, several symptoms showed consistent relationships, suggesting shared aspects of distress alongside culturally patterned variation in symptom expression. CONCLUSIONS:The influence of ethnicity on both symptom levels and symptom co-occurrence underscores the importance of culturally informed assessment. These findings highlight the need for services to consider culturally relevant symptom presentations to promote more equitable and appropriate mental health care.
Introduction Cumulative interpersonal traumatisation increases the risk of psychosis and is linked to psychotic symptom severity and reduced recovery rates. Psychosis and treatment themselves can also be traumatising, with a first episode of psychosis posing challenges to one’s identity. Despite a growing evidence base for the safety and effectiveness of trauma therapies for psychosis, implementation remains poor in early intervention for psychosis (EIP) services, partly due to resource constraints. Narrative exposure therapy (NET) is an effective intervention for post-traumatic stress disorder in ethnically diverse populations. Crucially it has potential to address barriers to implementation of trauma therapies in EIP as it has a brief duration with minimal training requirements. This feasibility study will evaluate the feasibility and acceptability of conducting a definite trial of NET in people with early psychosis.Methods and analysis An individually randomised parallel groups feasibility randomised controlled trial with embedded qualitative evaluation will be conducted. 50 individuals with first episode psychosis and a history of multiple trauma under the care of an EIP service in two NHS trusts in England will be recruited. Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessor blinded assessments will be conducted at baseline, 4 months (post-intervention) and 8 months (follow-up). Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects to inform planning for a fully powered trial. Qualitative interviews will be carried out with participants allocated to NET and clinicians to investigate acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms and recommendations. A sub-study in the NET group will investigate acceptability of completing Experience Sampling Data daily during therapy to monitor changes on candidate primary and secondary outcomes.Ethics and dissemination This study received REC/HRA ethical approval from the London - City & East Research Ethics Committee (REC) (25/LO/0350). The results of the study will be reported and disseminated at international conferences and in open-access peer-reviewed scientific journals.Trial registration number ISRCTN39471182.
Background Evidence on age at diagnosis of dementia and differentiation of dementia subtypes in Bangladesh is limited. This study aimed to determine age at diagnosis, examine factors associated with dementia subtypes, and evaluate the discriminatory utility of neuroimaging scales in a Bangladeshi clinical population. Methods The Community Awareness and Research on Early Dementia (CARED) study was a cross-sectional observational study conducted 2019−2024 at a tertiary care centre in Bangladesh. A total of 658 adults presenting with cognitive impairment, undergoing evaluation for suspected dementia were included. Diagnoses were established using DSM-5 criteria by a multidisciplinary team. Patients were categorized into dementia subtypes. Pseudodementia was retained as separate comparator group. Multivariable regression analyses were performed to identify factors associated with dementia subtypes. Receiver operating characteristic (ROC) curve analyses were used to assess the discriminatory performance of neuroimaging scales. Results Among 658 patients, Alzheimer’s-related dementia (ARD) accounted for 51.7% of cases. The mean age at diagnosis was significantly higher in ARD compared with non-Alzheimer’s-related dementia (nARD) (67.7 ± 10.8 vs 64.3 ± 11.4 years, P < 0.001). In multivariable analysis, nARD was associated with an earlier age at diagnosis by 4.3 years compared with ARD. Vascular dementia was associated with hypertension, OR 4.2 (95% CI 1.1–16.6), P = 0.04, and smoking, OR 13.1 (95% CI 1.6–103.3), P = 0.01. Neuroimaging scales demonstrated variable discriminatory performance. Medial temporal atrophy showed good discrimination for ARD (AUROC 0.752), while Fazekas scores demonstrated good performance for vascular dementia (AUROC 0.838) and mixed dementia (AUROC 0.836). Global cortical atrophy showed moderate discriminatory ability for frontotemporal dementia (AUROC 0.659). Conclusions Age at diagnosis varied across dementia subtypes in this Bangladeshi clinical cohort, with non-Alzheimer’s diagnosed earlier than Alzheimer’s. Structured MRI visual rating scales showed variable subtype-specific discriminatory performance, suggesting that they may provide adjunctive information for dementia subtype differentiation when interpreted alongside multidisciplinary clinical assessment.
Aims and method DIALOG is a patient-reported outcome and experience measure. We analysed anonymised DIALOG scores routinely collected from East London NHS Foundation Trust. We aimed to (a) examine changes in DIALOG scores through the patient journey (‘assessment’, ‘review’ and ‘discharge’); and (b) assess the impact of community mental health (CMH) transformation by comparing pre- and post-DIALOG scores. We analysed 11 198 DIALOG scores from 5007 patients in 2018–2019 and 2021–2022. Results DIALOG scores improved across treatment stages in both years. There was no clear difference pre- and post-CMH transformation, although in 2021–2022 there were lower satisfaction scores at referral. Clinical implications DIALOG showed sensitivity to change, supporting the utility of this scale in the evaluation of mental health services. The impact of CMH transformation was difficult to assess, due to potential confounders such as the COVID-19 pandemic. Routinely collected DIALOG data can help evaluate patient outcomes over time and inform service improvements.
