Background: There is growing evidence that air pollution may impact mental health, however this is the first study to investigate its role in child and adolescent community mental health service use. Methods: This retrospective cohort study used electronic health records from a large South London mental healthcare provider to establish a cohort of young people first in contact with community mental health services between 2008 and 2012, who were then followed for up to 9 years. Baseline (3-month) residential nitrogen dioxide (NO2), particulate matter (PM)10 and PM2.5 exposure was estimated using the KCL urban model. Contacts over 1-, 5-, and 9-year periods were analysed in relation to air pollution using negative binomial regression. The potential effect-modifying role of high vs low greenspace exposure (residential normalised difference vegetation index) and age-, gender-, ethnicity- and disorder-specific differences were investigated using subgroup analyses. Findings: The sample consisted of 11,773 children and adolescents (3-17 years) who had first face-to-face contact with mental health services between 2008 and 2012. Consistent positive associations were observed between air pollution exposure and number of community mental health service (CMHS) contacts. For example, by Year 9 a clear dose-response pattern was evident between NO2 exposure and CMHS contacts, with an adjusted incidence rate ratio of 1.17 (95% CI=1.09 to 1.26) for service users in the highest quartile of exposure compared to the lowest quartile. Population Attributable Fractions (PAFs) suggested that bringing UK air quality in line with WHO recommendations could reduce CMHS contacts by 3-6%. Associations were most pronounced for boys and children (3-12 years) and were substantially attenuated in those living near high levels of greenspace. Interpretation: Residential air pollution exposure was associated with increased community mental health service contacts in children and adolescents, attenuated by high greenspace exposure, suggesting that policy changes acting on air quality and green infrastructure in urban settings could improve population-level mental health and reduce current strain on child and adolescent mental health services.

AIM:To explore the social context of violence for hospital-based and community nurses from different ethnic groups, the types of violence experienced or witnessed both in and outside the workplace, and its impact on mental and physical health. DESIGN:Cross-sectional, qualitative study using semi-structured interviews. METHODS:Semi-structured interviews were conducted online with 12 hospital-based and community nurses recruited from London, England, between May and August 2021. Data were analysed using reflexive thematic analysis. RESULTS:The sample comprised seven hospital nurses and five community nurses. Four themes were identified: (i) the social context in which nurses from different ethnic groups are exposed to community violence; (ii) types of workplace violence experienced or witnessed by hospital-based and community nurses from different ethnic groups; (iii) perceptions of the factors contributing to workplace violence; (iv) impacts of violence on mental and physical health outcomes. Using the social ecological framework and sociological theory of stress, these findings informed a conceptual stress process model of violence exposure for nurses. CONCLUSION:Nurses from different ethnic groups are exposed to violence both in and outside the workplace which negatively affects their mental and physical health. Effective violence prevention requires a multi-factorial approach that addresses the social and institutional factors contributing to violence, shifting the focus from individual measures to systemic organisational changes. IMPACT:The NHS workforce is currently more diverse than ever, and healthcare leaders must improve access to mental health and well-being resources for staff affected by workplace violence, particularly for those who hold multiple social identities at the intersection of ethnicity, gender and age. Prioritising this support is essential not only to safeguard against negative health outcomes but also to improve the recruitment and retention of healthcare professionals. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

BACKGROUND:Existing evidence on associations between exposure to air pollution and psychological distress from middle to older age is limited by consideration of short exposure periods, poor historical covariates, exposures and outcomes, and cross-sectional study designs. We aimed to examine this association over a 26-year period between ages 43 and 69. METHODS:We utilised data from the Medical Research Council National Survey of Health and Development Study (the 1946 British birth cohort). Land-use regression models estimated exposure to specific air pollutants using household addresses for 1991 (NO2), 2001 (PM10, NO2), and 2010 (NO2, NOx, PM10, PM2.5, PMcoarse, PM2.5abs). These were linked to the closest data collection wave at ages 43, 53 and 60-64, respectively. Psychological distress was assessed through the 28-item version of the General Health Questionnaire (GHQ-28), at ages 53, 60-64 and 69. Associations between each of the pollutants with psychological distress were analysed using generalised linear mixed models, adjusted for pollution exposure before age 43, assigned sex, social class, smoking status, neighbourhood deprivation, and previous mental health problems. We also examined effect modification by social class. RESULTS:At age 69, 2125 participants completed the GHQ-28. In fully adjusted models, higher NO2 exposure was associated with higher GHQ-28 scores across a 26-year period (β=0.023, 95%CI:0.005, 0.040 per interquartile range increase in exposure), whereas higher exposure to PM10 was associated with lower GHQ-28 scores across a 16-year period (β=-0.021, 95%CI:-0.037, -0.006). There was no evidence of associations between exposure to other pollutants at age 60-64 and GHQ-28 at age 69. We found no effect modification by social class. CONCLUSIONS:In this cohort there was some evidence of an association between higher cumulative exposure to NO2 and higher psychological distress, but mixed associations with other exposures. Policies to reduce pollutant exposure may help improve psychological symptoms in middle to late adulthood.

Introduction Black school students in the United Kingdom (UK) are exposed to racialized personal, institutional and systemic factors (e.g. racism and misogyny) that may impact their mental wellbeing and educational experiences. Minimal research exists to understand how racism and other adverse childhood experiences interact to shape students’ mental health and wellbeing as they progress through education before commencing university studies, which this study aimed to achieve. Methods Biographical Narrative Interpretive Method (BNIM) interviews (n = 15) were completed with Black UK university students who self-reported having struggled with mental health at school. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results Three main themes were derived from Interpretative phenomenological analysis (IPA), pertaining to the students’ experiences of adverse childhood experiences, racism-related stressors in education, and coping strategies. Discussion The findings add value by offering recommendations for psychologists, educators, and policymakers to address racism and poor mental wellbeing in schools and to improve experiences and outcomes for Black students. Recommendations include self-reflection tools, funding for mental wellbeing interventions and resources, and enhancing professional courses to incorporate anti-racist curricula and practices.

OBJECTIVE:To assess the effectiveness of NHS Talking Therapies (NHSTT) service for working-age adults with mild to moderate depression or anxiety and to evaluate the impact of multiple physical long-term conditions (LTCs) on treatment outcomes. METHOD:We have linked routinely collected data from the NHSTT services in South London (UK) with primary care data for aged 18-64 years who had accessed the services between August 2008 and March 2021. The main outcome measures were NHSTT service key performance indicators of 'recovery' and 'reliable improvement'. Multiple and specific physical LTCs represented the exposure of interest. Cox proportional hazard models were used to assess associations between physical LTC exposures and outcomes. FINDINGS:Among 35 814 adults (mean age=37, 67% women) attending the NHSTT, physical LTCs were associated with moderately lower 'recovery' rate (adjusted HR (aHR)=0.91, 95% CI 0.88 to 0.95) relative to no LTCs. A dose-response relationship was also observed: the likelihood of 'recovery' decreased with the number of physical LTCs (one condition: aHR=0.95, 95% CI 0.91 to 0.98; two conditions: aHR=0.88, 95% CI 0.83 to 0.93; three conditions: aHR=0.82, 95% CI 0.75 to 0.91; four or more conditions: aHR=0.72, 95% CI 0.61 to 0.85). CONCLUSION:Among working-age adults, the effectiveness of NHSTT services varied with the number and type of physical LTCs. These findings highlight the need for tailored interventions for patients with multiple physical LTCs to improve treatment outcomes.

BACKGROUND:Previous research has linked higher exposure to air pollution to increased cognitive impairment at older ages. We aimed to extend the existing evidence in this area by incorporating exposures across the life course in addition to measures of cognition and brain structural imaging in participants at midlife to older age. METHODS:For this population-based study, we used data from the Medical Research Council National Survey of Health and Development (NSHD; also known as the 1946 British Birth Cohort) and a neuroimaging substudy of the NSHD known as Insight 46. Participants were recruited after birth in a single week during March, 1946. Our objectives were to assess whether exposure to air pollutants in midlife (age 45-64 years) was associated with poorer processing speed and poorer verbal memory between the ages of 43 years and 69 years, and whether exposures were associated with poorer cognitive state and brain structure outcomes at age 69-71 years. Air pollution exposure data were available for nitrogen dioxide (NO2; ages 45-64 years); particulate matter with diameter less than 10 μm (PM10; ages 55-64 years); and nitrogen oxides (NOx) and particulate matter with diameters less than 2·5 μm (PM2·5) and between 2·5 μm and less than 10 μm (PMcoarse) and particulate matter absorbance (PM2·5abs) as a measure of black carbon absorption (ages 60-64 years), with adjustments for early-life exposures to black smoke and sulphur dioxide. Verbal memory was tested with a 15-item recall task and processing speed with a visual search task at ages 43, 53, 60-64, and 69 years. The Addenbrooke's Cognitive Examination III (ACE-III), a measure of cognitive state, was conducted at age 69 years. Whole-brain, ventricular, hippocampal, and white matter hyperintensity volumes were assessed by MRI at age 69-71 years. Generalised linear models and generalised mixed linear models were used to explore associations between pollution exposure, cognitive measures, and brain structural outcomes, adjusted for sociodemographic factors including smoking status and neighbourhood deprivation. FINDINGS:Between the ages of 43 years and 69 years, we included 1534 NSHD participants in the verbal memory and processing speed analysis. Of 2148 participants who underwent testing during the wave of follow-up in 2015-16, at age 69 years, 1761 were included in the ACE-III analysis. Of the 502 NSHD participants recruited into the Insight 46 substudy, 453 were included in the analysis. Higher exposure to NO2 and PM10 was associated with slower processing speed between the ages of 43 years and 69 years (NO2 β -8·121 [95% CI -10·338 to -5·905 per IQR increase in exposure]; PM10 β -4·518 [-6·680 to -2·357]). Higher exposure to all tested pollutants was associated with lower ACE-III score at age 69 years (eg, NO2 β -0·589 [-0·921 to -0·257]). Higher exposure to NOx was associated with smaller hippocampal volume (β -0·088 [-0·172 to -0·004]) and higher exposure to NO2 and PM10 was associated with larger ventricular volume (NO2 β 2·259 [0·457 to 4·061]; PM10 β 1·841 [0·013 to 3·669]) at age 69-71 years. INTERPRETATION:Acknowledging the probable effects of exposure early in life, higher exposure to nitrogen dioxide, nitrogen oxides, and coarse particulate matter in midlife to older age was associated with poorer cognition, processing speed, and brain structural outcomes, strengthening evidence for the adverse effects of air pollution on brain function in older age. FUNDING:The National Institute for Health and Care Research, the Medical Research Council (MRC), Alzheimer's Research UK, the Alzheimer's Association, MRC Dementias Platform UK, and Brain Research UK.

Despite a preponderance of evidence and considerable resources, health and social inequities persist, and in many cases, are widening. These inequities are not simply the result of passive structural and economic conditions but are actively maintained through institutional processes, norms, and ideologies that uphold the status quo. Reform within health inequities research, policy, and health and social care practice is therefore critical to disrupting these entrenched systems and catalysing both bottom-up and top-down change. We aimed to develop agreement for an iterative set of guiding principles underpinning ways of working for a newly formed Health and Social Equity Collective comprising researchers, community leaders, policymakers, and health and care professionals, seeking to address inequity by identifying and engaging the levers of change within and across institutions. The principles aim to inform a more inclusive and translational knowledge base through research practices, tackling entrenched inequalities in education, training, and capacity-building; and centring communities affected by health inequities through engagement and advocacy. We carried out a modified Delphi consensus process between March and September 2022 with Collective members and networks through online workshops and surveys. Out of 24 consensus statements developed and refined over a workshop and three successive survey rounds, we identified eleven key principles agreed upon by a majority of respondents. Two of these were rated high priority by over 75% of respondents, four by over 60% and five by over 50%. These could be grouped into three main topics detailing ways of working and change needed within: 'Knowledge and framing of health and social inequities, and incorporation into practice', 'Community engagement, involvement and peer research', and 'Organisational culture change', respectively. Given the pressing need to address inequities, these principles offer a grounding for future consensus building initiatives which also incorporate a wider diversity of perspectives, and which should be iteratively updated with ongoing learning from health equity initiatives nationally and internationally.

OBJECTIVE:A better understanding of fatigue and chronic fatigue symptoms in the community may lead to better targeted preventative interventions. This study aims to estimate the prevalence of fatigue and chronic fatigue and explore relationships with sociodemographic and psychosocial factors in a representative community population survey in London, UK. METHODS:The first wave of the South East London Community Health study (2008 to 2010) surveyed face-to-face 1698 individuals aged 16 years and over from 1075 randomly selected households in the boroughs of Southwark and Lambeth. Self-reported fatigue and/or chronic fatigue was determined using the Chalder fatigue scale. Ordinal and binary logistic regression analyses were undertaken to assess the association of sociodemographic and psychosocial factors with higher levels of fatigue symptoms. RESULTS:The point prevalence of fatigue was 23.5 % (95 % CI 21.5-25.7). After adjusting for age and sex, higher levels of fatigue were substantially associated with impacts on work and other activities due to physical (OR: 4.87 (95 % CI 3.44-6.88)) or emotional symptoms (OR: 4.52 (95 % CI, 3.16-6.48)). Higher levels of fatigue were also associated with seeking emotional help from professionals (OR: 2.73 (95 % CI, 1.91-3.92) or family or friends (OR: 2.37 (95 % CI,1.68-3.34) and reporting less perceived instrumental (OR: 2.01 (0.75-5.37)) and emotional support (OR: 3.76 (1.46-9.68)). CONCLUSION:Our findings highlight the high prevalence of fatigue and chronic fatigue in a representative urban community sample. Higher levels of fatigue were significantly associated with greater disability and formal and informal help-seeking. The quality of perceived social support is an important protective factor.

Abstract Background Biases held by healthcare practitioners can shape clinical interactions, leading to discrimination and poor patient outcomes. Traditional methods, such as vignettes or self-report measures, often lack ecological validity. Objective We evaluated a novel VR simulation designed to explore bias and discrimination in clinical decision-making. Methods Thirty-five healthcare practitioners across 14 NHS trusts completed an in-person VR simulation and provided feedback on realism, immersion, and usability via surveys and open-ended responses. Patients in the simulation had intersecting sociodemographic characteristics (race, gender, migration status). Results Most participants rated the VR environment as at least moderately realistic (88.6%), with 42.9% rating it very or extremely realistic. Nearly half (45.7%) reported consistency with real-world experience. Open-text feedback highlighted strengths in realism, immersion, and educational potential, with suggestions to improve dialogue flexibility. Conclusions VR is a feasible, immersive, and scalable tool for investigating bias in clinical decision-making. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This paper represents independent research funded by the Wellcome Trust [203380/Z/16/Z] and the Economic and Social Research Council [ES/V009931/1]. J.O. is part-funded by the NIHR Biomedical Research Centre [BRC121520018] at South London and Maudsley NHS Foundation Trust. S.L.H. and R.R. are supported by the Economic and Social Research Council Centre for Society and Mental Health at King's College London [ES/S012567/1] and by UK Research and Innovation [MR/Y030788/1] as part of Population Health Improvement UK (PHI-UK), a national research network that seeks to transform health and reduce inequalities through change at the population level. S.L.H, R.R, J.O and H.W are supported by the Wellcome Trust [308556/Z/23/Z], S.L.H. currently receives funding from Impact on Urban Health part of Guy's & St Thomas' Foundation [EIC210605 and EIC221208], the Swedish Research Council [2023-05959] and the Wellcome Trust [28117/Z/23/Z & 223486/Z/21/Z]. The funders had no involvement in study design, data collection, analysis, interpretation or the decision to submit for publication. The views expressed are those of the author(s) and not necessarily those of the funders. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Kings College London Research Ethics Committee for Psychiatry, Nursing and Midwifery and the NHS Health Research Authority gave ethical approval for this work (KCL Ref: HR-17/18-4629; HRA Ref: 18/HRA/0368) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is available for research purposes upon request. All requests are reviewed by the study data committee. To apply for access to this data please contact care_hsc{at}kcl.ac.uk

Significant numbers of people in England have fallen into a gap between primary care psychological therapies and specialist mental health services. We aim to examine pathways to care by looking at demographic variation in detection and referral to primary and secondary psychological services in south London. Longitudinal descriptive study using a record linkage between a primary care database (Lambeth DataNet) and a secondary care mental health database (CRIS). We extracted data on mental health diagnosis, prescriptions and episodes of care in mental health services for all patients of working age registered from 1 January 2008 to 1 March 2018 (pre-covid era). Of those with a mental disorder detected in primary care (n = 110,419; 26.8

Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it is crucial to improve the health and social outcomes for these individuals through age and culturally appropriate interventions. This paper aims firstly to describe the development and implementation of the HYPE project platform (a research and resource platform co-designed and co-produced with young people). The second aim is to describe the characteristics of participants who engaged with the platform and an embedded pilot online survey. Participatory action research approach was used to address objectives of the HYPE project. Data were analysed to: (1) help improve access to health and social services, (2) guide provision of information of online resources and (3) deliver complementary community-based events/activities to promote mental health and to ultimately prevent mental health issues. Pilot and main phases of the HYPE project demonstrated the capacity and feasibility for such a platform to reach local, national, and international populations. Analyses demonstrated that the platform was particularly relevant for young females with pre-existing health difficulties. Some of the barriers to involving young people in research and help-seeking are discussed.

Background Schizophrenia (SCZ) is a complex neuropsychiatric disorder with unknown aetiology, although accumulating evidence suggests a combined role of genetic, environmental and neurodevelopmental factors. Evidence from family, case-control and, more recently, genetic studies suggest a possible relationship between SCZ and alterations of the immune system. Studies investigating basal levels of inflammation have generally reported increased proinflammatory cytokines in the serum of individuals with SCZ compared to individuals with no history of psychosis. However, the origin of this relationship is unknown. Recent genome-wide association studies (GWAS) have identified numerous single-nucleotide polymorphisms (SNPs) associated with risk of SCZ. Interestingly, many of the risk SNPs are found in or near genes involved in immunity, and SCZ shows comorbidity with several inflammatory related conditions. In this study, we aim to investigate the relationship between polygenic risk scores for SCZ and peripheral cytokine levels both under basal conditions and following stimulation with a viral-like agent. Methods To consider the effect of SCZ PRS on basal cytokine levels, we measured 36 cytokines in blood serum from 406 unrelated individuals from the South East London Community Health study (SELCoH) using multiplex ELISA-based technology. Schizophrenia polygenic risk scores (PRS) for these individuals were calculated using PRSice-2 and summary statistics from a large genome-wide association study for SCZ (European ancestry). Linear regression models considered associations between PRS for SCZ and levels of cytokines. Age, sex, BMI and batch were included as covariates.To consider the effect of viral-like stimulation on inflammatory cytokine release and the moderating effect of SCZ PRS, peripheral blood mononuclear cells (PBMCs, n=100) from a second independent sample were utilised. We tested how PRS for SCZ moderates release of 10 cytokines following exposure to viral like-stimulation. Experiments are currently ongoing, but involve culturing PBMCs and treating them with polyinosinic:polycytidylic acid (poly I:C) or a vehicle control. 10 cytokines released into cell media over a 24-hour period will be measured using multiplex ELISA-based technology. Age, sex, batch and site of collection will be considered as covariates. Finally, we will use flow cytometry on a subset of these PBMC samples to assess differences in cell subpopulations between groups. Results For basal conditions in blood serum, we found a nominally significant association between PRS for SCZ and serum levels of IFN-a (p= 0.05), sICAM (p= 0.035) and eotaxin-3 (p= 0.016). We also found nominally significant associations between PRS for SCZ and serum levels of IFN-g (p= 0.002), VEGF (p= 0.03) and MIP-1b (p= 0.02) in males only. In the conference, we will also present results from our ongoing experiments in PBMCs including descriptive summary statistics of the analysed cytokines before and after poly I:C treatment, variance in cytokine levels explained by PRS for SCZ, and the main associations of PRS with each cytokine and with PBMC subpopulations. Discussion This study will further our understanding of the shared genetic mechanisms underlying risk for schizophrenia and altered immune function.

Abstract Introduction The proportion of working-age people with one or more long-term conditions (LTCs) is rising. It is important to understand the risk factors underlying the progression of LTCs and how LTCs impact on employment. This study aimed to determine risk factors predicting the initial development and progression of LTCs in working-age people living in South East London UK, and the associations between LTCs and employment. Methods South East London Community Health (SELCoH) data from two timepoints 3 years apart in participants aged 16 to 64, were analysed. The prevalence of LTCs was compared between these 2 timepoints, and how LTCs are distributed across employment categories. Multinomial logistic regression was used to identify associations between socio-demographic, socioeconomic (including employment status), psychosocial and health-related risk factors, and the initial progression from 0 to 1-or-more LTCs, and progression from 1-to-many LTCs. Multinomial logistic regression was also used to investigate the impact of the development and progression of LTCs on employment. Results Stressful life events and social isolation were risk factors associated with the progression of LTCs. Part-time employment, unemployment and not working due to disability or early retirement were associated with increased risk of progressing from one-to-many LTCs compared with full-time employment. Discussion Interventions to prevent progression of LTCs should include reduction of social isolation and consider the impact of stressful life events. An important finding was that full-time employment is associated with reduced progression from one-to-many LTCs. Conclusion Future research should establish what aspects of employment protect against the progression of LTCs.

Purpose People with severe mental illness (SMI) experience high levels of unemployment. We aimed to better understand the associations between clinical, social, and demographic inequality indicators and unemployment. Methods Data were extracted from de-identified health records of people with SMI in contact with secondary mental health services in south London, UK. A Natural Language Processing text-mining application was applied to extract information on unemployment in the health records. Multivariable logistic regression was used to assess associations with unemployment, in people with SMI. Results Records from 19,768 service users were used for analysis, 84.9% ( n = 16,778) had experienced unemployment. In fully adjusted models, Black Caribbean and Black African service users were more likely to experience unemployment compared with White British service users (Black Caribbean: aOR 1.62, 95% CI 1.45–1.80; Black African: 1.32, 1.15–1.51). Although men were more likely to have experienced unemployment relative to women in unadjusted models (OR 1.36, 95% CI 1.26–1.47), differences were no longer apparent in the fully adjusted models (aOR 1.05, 95% CI 0.97–1.15). The presence of a non-affective (compared to affective) diagnosis (1.24, 1.13–1.35), comorbid substance use (2.02, 1.76–2.33), previous inpatient admissions (4.18, 3.71–4.70), longer inpatient stays (78 + days: 7.78, 6.34–9.54), and compulsory admissions (3.45, 3.04–3.92) were associated with unemployment, in fully adjusted models. Conclusion People with SMI experience high levels of unemployment, and we found that unemployment was associated with several clinical and social factors. Interventions to address low employment may need to also address these broader inequalities.

Background Workplace violence is a serious threat to staff safety and leads to mental and physical health problems that have negative consequences for the recruitment and retention of nurses, amid the worst staffing crisis in the history of the National Health Service (NHS) in the United Kingdom.Objectives This study aims to explore the social context of violence for hospital-based and community nurses from different ethnic groups, the types of violence experienced or witnessed both in and outside the workplace, and the impact of violence on mental and physical health.Methods Semi-structured interviews were conducted online with 12 hospital-based and community nurses recruited across London. Interview data were analysed using reflexive thematic analysis.Results The sample comprised seven hospital nurses and five community nurses. Four themes were identified from the analysis: i) the social context in which nurses from different ethnic groups are exposed to community violence; ii) the types of workplace violence experienced or witnessed by hospital-based and community nurses from different ethnic groups; iii) nurses’ perceptions of the factors contributing to workplace violence iv) how violence impacts mental and physical health outcomes for hospital-based and community nurses from different ethnic groups. Based on the social ecological framework and the sociological theory of stress, we have used these findings to present a conceptual stress process model of violence exposure for nurses.Conclusions Hospital-based and community nurses from different ethnic groups are exposed to violence both in and outside the workplace which negatively affects their mental and physical health. Whilst interventions aimed at improving personal safety and security measures in hospitals are valuable, interventions to address the social and institutional factors that put nurses at risk of violence exposure are needed. Further research using wider criteria for violence to include witnessing and hearing about violent events are needed to advance our understanding of how nurses are affected by multiple sources and types of violence in both their work and personal lives.What is already known What this paper adds ### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study was funded by the Economic and Social Research Council ([www.esrc.ukri.org][1]) and NHS England, through the London Interdisciplinary Social Science Doctoral Training Partnership ([www.liss-dtp.ac.uk][2]) [ES/P000703/1]. The funders had no involvement in study design, data collection, analysis, interpretation or the decision to submit for publication. The views expressed are those of the author(s) and not necessarily those of the funders.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Research Ethics Committee for Psychiatry, Nursing and Midwifery of King's College London gave ethical approval for this work (HR/DP-20/21-22048).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors [1]: http://www.esrc.ukri.org [2]: http://www.liss-dtp.ac.uk

Objectives This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study.Methods An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622).Results Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health.Conclusions Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.

AIM:To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups.DESIGN:A qualitative thematic analysis with an inductive approach.METHODS:Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement.RESULTS:Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS.CONCLUSION:These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity.IMPACT:Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

Objectives The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time. Methods We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years. Results Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (beta = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time. Conclusions Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847

Purpose Existing evidence on the mental health consequences of disadvantaged areas uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to investigate this association over a 69-year period. Methods Data were obtained from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort), which consisted of 2125 participants at 69 years. We assessed longitudinal associations between area disadvantage and mental health symptoms at adolescence and adulthood with use of multilevel modelling framework. Results After adjustment for father’s social class, for each one percentage increase in area disadvantage at age 4, there was a 0.02 (95% CI 0.001, 0.04) mean increase in the total score of the neuroticism scale at age 13–15. After adjustment for father’s social class, adult socio-economic position, cognitive ability and educational attainment, a one percentage increase in change score of area disadvantage between age 4 and 26 was associated with a mean increase in the total Psychiatric Symptom Frequency score (MD 0.06; 95% CI 0.007, 0.11). Similar associations were observed with change scores between ages 4, 53, 60 and total General Health Questionnaire-28 score at age 53 (MD 0.05; 95% CI 0.01, 0.11) and 60–64 (MD 0.06; 95% CI 0.009, 0.11). Conclusions Cohort members who experienced increasing area disadvantage from childhood were at increased risk of poor mental health over the life course. Population-wide interventions aiming at improving social and physical aspects of the early neighbourhood environment could reduce the socio-economic burden of poor mental health.

Understanding how different Black and other racially minoritised communities thrive is an emerging priority area in mental health promotion. Literature demonstrates health benefits of social capital (social resources embedded within social networks). However, its effects are not always positive, particularly for certain subpopulations who are already disadvantaged.The CONtributions of social NEtworks to Community Thriving (CONNECT) study will use Participatory Action Research (PAR) to investigate social capital as a resource that benefits (or hinders) racially minoritised communities and their mental health. The CONNECT study was designed within a partnership with community organisations and responds to local policy in two South-East London Boroughs, thereby providing potential channels for the action component of PAR. Taking an anti-racism lens, we acknowledge the underpinning role of racism in creating health inequities. We apply an intersectional framework to be considerate of overlapping forms of oppression such as age, gender, socioeconomic status, and sexual orientation as an essential part of developing effective strategies to tackle health inequities. Key components of this mixed methods PAR study include (1) involving racialised minority community members as peer researchers in the team (2) collecting and analysing primary qualitative data via interviews, photovoice, and community mapping workshops, (3) developing relevant research questions guided by peer researchers and collaborating organisations and analysing secondary quantitative data accordingly, (4) integrating qualitative and quantitative phases, and (5) working closely with community and policy partners to act on our findings and use our research for social change.The PAR approach will allow us to engage community (voluntary sector and government) and academic partners in decision making and help address imbalances in power and resource allocation. Knowledge generated through this collaborative approach will contribute to existing community initiatives, policies, and council strategies. This will ensure the views and experiences of racially minoritised communities drive the changes we are collaboratively committed to achieving.