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This review aimed to systematically review observational studies investigating the longitudinal association between anxiety, depression and quality of life (QoL). A systematic search of five electronic databases (PubMed, PsycINFO, PSYNDEX, NHS EED and EconLit) as well as forward/backward reference searches were conducted to identify observational studies on the longitudinal association between anxiety, depression and QoL. Studies were synthesized narratively. Additionally, a random-effects meta-analysis was performed using studies applying the mental and physical summary scores (MCS, PCS) of the Short Form Health Survey. The review was prospectively registered with PROSPERO and a study protocol was published. n = 47 studies on heterogeneous research questions were included, with sample sizes ranging from n = 28 to 43,093. Narrative synthesis indicated that QoL was reduced before disorder onset, dropped further during the disorder and improved with remission. Before onset and after remission, QoL was lower in comparison to healthy comparisons. n = 8 studies were included in random-effects meta-analyses. The pooled estimates of QoL at follow-up (FU) were of small to large effect sizes and showed that QoL at FU differed by disorder status at baseline as well as by disorder course over time. Disorder course groups differed in their MCS scores at baseline. Effect sizes were generally larger for MCS relative to PCS. The results highlight the relevance of preventive measures and treatment. Future research should consider individual QoL domains, individual anxiety/depressive disorders as well as the course of both over time to allow more differentiated statements in a meta-analysis.

This study seeks to explore the association between grandchild care and Attitudes Towards Own Ageing, assessing whether the commencement of, or ceasing, grandchild care is associated with changes in grandparents' perspectives on ageing. Longitudinal data were drawn from a population-based sample of community-dwelling individuals aged ≥40 years in Germany. The Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Moral Scale (PGCMS) was used to measure Attitudes Towards Own Ageing. To determine whether respondents provided grandchild care, respondents were asked \"I'd now like to go on to learn more about your activities and pastimes. Do you supervise other people's children privately, e.g. your grandchildren, or the children of siblings, neighbors, friends or acquaintances?\" Symmetric and asymmetric linear fixed effects regressions were used to assess within-person changes longitudinally. No statistically significant association between providing care for grandchildren and Attitudes Towards Own Ageing was found. Significant associations were found between Attitudes Towards Own Ageing and employment status. Namely, retirement was associated with more positive Attitudes Towards Own Ageing (β = 0.57, p < .001), as was not being employed (β = 0.57, p < .001). A significant association between self-rated health and Attitudes Towards Own Ageing was also found (β = -0.06, p < .001), with poorer self-rated health associated with more negative Attitudes Towards Own Ageing. Our findings suggest that undertaking grandchild care does not shape Attitudes Towards Own Ageing. As our findings did not align with existing evidence on the associations between grandchild caregiving and measures of subjective ageing, further research is required.

ObjectiveThe aim of this study was to examine whether there is an association between grandparental care and loneliness, social isolation and/or the size of an individual’s social network among community-based adults aged ≥40 years.MethodsCross-sectional data were drawn from a population-based sample of individuals aged ≥40 years living in the community in Germany. Loneliness was measured using a short version of the De Jong Gierveld Loneliness Scale. Social isolation was measured using a scale developed by Bude and Lantermann. The number of important people with whom respondents have regular contact (ie, social network size) was also used as an outcome variable. All respondents were asked whether they privately provide grandparent care (no/yes).ResultsLinear regressions showed reduced loneliness (β=−0.06, p<0.01) and social isolation scores (β=−0.04, p<0.05) among those undertaking care of a grandchild. Regression analysis also showed an increased number of important people with whom individuals had regular contact among those who undertook care of a grandchild (β=1.02, p<0.001).ConclusionFindings indicate a positive association between undertaking the care of a grandchild and the size of an individual’s social network, and a negative association between grandchild care and self-rated scores of loneliness and social isolation. These findings build on existing research into the social and health implications of grandchild care among grandparents. Longitudinal studies are required to strengthen the understanding of this association.

Background and study objectivesThis study aimed to assess among Ukrainian adults: (1) knowledge of mental disorders; (2) attitudes towards people with mental health disorders, and to the delivery of mental health treatment within the community; and (3) behaviours towards people with mental disorders.MethodologyA cross-sectional survey of Ukrainian adults aged 18–60 was conducted. Stigma-related mental health knowledge was measured using the mental health knowledge schedule. Attitude towards people with mental health disorders was assessed using the Community Attitudes towards Mental Illness scale. The Reported and Intended Behaviour scale was used to assess past and future intended behaviour towards people with mental health disorders.ResultsAssociations between gender, age, and educational level and the knowledge and attitudes measures were identified. There was evidence of a positive association between being male and positive intended behaviours towards people with mental health disorders [mean difference (MD) = 0.509, 95% confidence interval (CI) 0.021–0.998]. Older age was negatively associated with positive intended behaviours towards people with mental health disorders (MD = −0.017, 95% CI 0.0733 to −0.001). Higher education was positively associated with stigma-related mental health knowledge (MD = 0.438, 95% CI 0.090–0.786), and negatively associated with authoritarian (MD = 0.755, 95% CI 0.295–1.215) attitudes towards people with mental health problems.ConclusionOverall, the findings indicate a degree of awareness of, and compassion towards, people with mental illness among Ukrainian adults, although this differed according to gender, region, and education level. Results indicate a need for the adoption and scaling-up of anti-stigma interventions that have been demonstrated to be effective.

Purpose The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict). Design/methodology/approach A literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context. Findings The literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need; targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways. Research limitations/implications This study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settings Originality/value The paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war.

Objective This study seeks to explore the association between grandchild care and Attitudes Towards Own Ageing, assessing whether the commencement of, or ceasing, grandchild care is associated with changes in grandparents’ perspectives on ageing. Methods Longitudinal data were drawn from a population-based sample of community-dwelling individuals aged ≥40 years in Germany. The Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Moral Scale (PGCMS) was used to measure Attitudes Towards Own Ageing. To determine whether respondents provided grandchild care, respondents were asked “I’d now like to go on to learn more about your activities and pastimes. Do you supervise other people’s children privately, e.g. your grandchildren, or the children of siblings, neighbors, friends or acquaintances?” Symmetric and asymmetric linear fixed effects regressions were used to assess within-person changes longitudinally. Results No statistically significant association between providing care for grandchildren and Attitudes Towards Own Ageing was found. Significant associations were found between Attitudes Towards Own Ageing and employment status. Namely, retirement was associated with more positive Attitudes Towards Own Ageing (β = 0.57, p < .001), as was not being employed (β = 0.57, p < .001). A significant association between self-rated health and Attitudes Towards Own Ageing was also found (β = -0.06, p < .001), with poorer self-rated health associated with more negative Attitudes Towards Own Ageing. Conclusion Our findings suggest that undertaking grandchild care does not shape Attitudes Towards Own Ageing. As our findings did not align with existing evidence on the associations between grandchild caregiving and measures of subjective ageing, further research is required.

IntroductionEvidence from individual longitudinal studies suggests that anxiety and depression may impact quality of life. However, systematic reviews synthesising current evidence have mainly focused on specific samples. Thus, the aim of this study is to synthesise evidence from longitudinal studies on the association between anxiety, depression and quality of life in a systematic review.Methods and analysisA systematic review of evidence from longitudinal studies analysing the association between anxiety, depression and quality of life will be conducted, taking into account the current Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Several electronic databases from relevant fields of research (PubMed, PsycINFO, PSYNDEX, EconLit, NHS EED) will be searched in September 2018 using defined search terms, with an updated search planned. Moreover, reference lists of included studies will be searched manually. Study eligibility will be appraised in a two-step process against pre-defined inclusion/exclusion criteria. Primarily, information on study design and assessment, statistical methods, participant characteristics as well as results regarding our research question will be extracted. The quality of included studies will be assessed using an appropriate tool. Study selection, data extraction and assessment of study quality will be performed by two reviewers. Disagreements will be resolved through discussion or by inclusion of a third party. Results will be synthesised narratively in text and tables. Depending on the number and heterogeneity of the studies included, a meta-analysis will be performed.Ethics and disseminationAs no primary data will be collected, approval from an ethics committee is not required. Results will be disseminated through conference presentations and publication in a peer-reviewed, scientific journal.PROSPERO registration numberCRD42018108008.

Neonatal sepsis is a serious public health problem; however, there is substantial heterogeneity in the outcomes measured and reported in research evaluating the effectiveness of the treatments. Therefore, we aim to develop a Core Outcome Set (COS) for studies evaluating the effectiveness of treatments for neonatal sepsis. Since a systematic review of key outcomes from randomised trials of therapeutic interventions in neonatal sepsis was published recently, we will complement this with a qualitative systematic review of the key outcomes of neonatal sepsis identified by parents, other family members, parent representatives, healthcare providers, policymakers, and researchers. We will interpret the outcomes of both studies using a previously established framework. Stakeholders across three different groups i.e., (1) researchers, (2) healthcare providers, and (3) patients’ parents/family members and parent representatives will rate the importance of the outcomes in an online Real-Time Delphi Survey. Afterwards, consensus meetings will be held to agree on the final COS through online discussions with key stakeholders. This COS is expected to minimize outcome heterogeneity in measurements and publications, improve comparability and synthesis, and decrease research waste.

Background Delphi surveys are commonly used to prioritise critical outcomes in core outcome set (COS) development. This trial aims to compare a three-round (Multi-Round) Delphi (MRD) with a Real-Time Delphi (RTD) in the prioritisation of outcomes for inclusion in a COS for neonatal encephalopathy treatments and explore whether ‘feedback’, ‘iteration’, and ‘initial condition’ effects may occur in the two survey methods. Methods We recruited 269 participants (parents/caregivers, healthcare providers and researchers/academics) of which 222 were randomised to either the MRD or the RTD. We investigated the outcomes prioritised in each survey and the ‘feedback’, ‘iteration’, and ‘initial condition’ effects to identify differences between the two survey methods. Results In the RTD, n  = 92 participants (83%) fully completed the survey. In the MRD, n  = 60 participants (54%) completed all three rounds. Of the 92 outcomes presented, 26 (28%) were prioritised differently between the RTD and MRD. Significantly fewer participants amended their scores when shown stakeholder responses in the RTD compared to the MRD (‘feedback effect’). The ‘iteration effect’ analysis found most experts appeared satisfied with their initial ratings in the RTD and did not amend their scores following stakeholder response feedback. Where they did amend their scores, ratings were amended substantially, suggesting greater convergence. Variance in scores reduced with subsequent rounds of the MRD (‘iteration effect’). Whilst most participants did not change their initial scores in the RTD, of those that did, later recruits tended to align their final score more closely to the group mean final score than earlier recruits (an ‘initial condition’ effect). Conclusion The feedback effect differed between the two Delphi methods but the magnitude of this difference was small and likely due to the large number of observations rather than because of a meaningfully large difference. It did not appear to be advantageous to require participants to engage in three rounds of a survey due to the low change in scores. Larger drop-out through successive rounds in the MRD, together with a lesser convergence of scores and longer time to completion, indicate considerable benefits of the RTD approach. Trial registration NCT04471103. Registered on 14 July 2020.

Background The Delphi method is used in a wide variety of settings as a method of building consensus on important issues. Traditionally, the Delphi method uses multiple rounds of a survey to allow for feedback of other participants’ survey responses in between rounds. By informing participants about how others answer a question or prioritise specific topics, it allows for diverse opinions to inform the consensus process. For this reason, the Delphi method is popular as a consensus building approach in developing core outcome sets (COS), i.e. the minimum agreed set of standardised outcomes that should be measured and reported in studies on a specific health condition. In a COS setting, participants prioritise the importance of outcomes for inclusion in a COS. This usually involves participating in multiple rounds of a survey that can span several weeks or months. Challenges with participant retention have been highlighted in previous COS. We will compare a three-round with a Real-Time Delphi approach on prioritised outcomes. This trial is embedded within the COHESION study which is developing a COS for interventions treating neonatal encephalopathy. Methods One hundred and eighty stakeholders (parents/caregivers of infants diagnosed and treated with neonatal encephalopathy, healthcare providers and researchers) will be randomised using stratified randomisation to take part in either the Multi-Round or Real-Time Delphi. Stakeholders will rate the importance of the same set of outcomes in both arms. We will compare the prioritised outcomes at the end of both surveys as well as other parameters such as feedback, initial condition and iteration effects. Discussion This trial will provide evidence to inform decisions on the use of Multi-Round compared to Real-Time Delphi survey methods. Trial registration NCT04471103 . Registered on 14 July 2020.