Paul E Bebbington

• MA, MPhil, PhD, FRCP, FRCPsych
• Professor at University College London

Introduction Religiosity is believed to be a factor that may reduce the risk of addiction and substance use both in adults and in young people. It is a complex construct that is neither measurable nor objectifiable, thus it must be estimated from proxy characteristics. For this purpose, researchers differentiate between subjective religiosity (i.e....

Religiosity may reduce the risk of substance use in adults and young people. However, religiosity is a complex construct, variously defined and assessed. We explored the role of different religious components: intrinsic (subjective), extrinsic-personal (service attendance) and extrinsic-social (church-based social activities) in deterring cannabis...

Background: Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect. Method: We analysed English data fro...

In an initiative to reduce stigma, an academic psychiatrist comes out of the dementia closet: describing his own experience of developing Alzheimer's disease, the accompanying memory problems, the restriction of some of his activities, emotional lability and his increasing reliance on others.

In the last four decades, mental health services for people with Severe Mental Illness (SMI) have seen asylums replaced by a balanced model of Community Mental Healthcare (CMH). Innovative approaches and strategies in the field of CMH have been extensively researched. However, this research has been hampered by issues limiting their capacity to inf...

Human beings are social animals, and social psychiatry is a key discipline within psychiatry around the world. The impact of social factors on the genesis and perpetuation of mental illnesses and maintenance of well-being of individuals and families is well recognized. Exploring social factors is the key to understanding aetiology and developing th...

Human beings are social animals, and social psychiatry is a key discipline within psychiatry around the world. The impact of social factors on the genesis and perpetuation of mental illnesses and maintenance of well-being of individuals and families is well recognized. Exploring social factors is the key to understanding aetiology and developing th...

Background Subjective well-being in people with schizophrenia is likely to be impaired by positive and negative psychotic symptoms. However, these may impact differentially on hedonic (satisfaction and interest in life) and eudaemonic (optimal psychological and social functioning) components. Aims We hypothesized that positive symptoms would influ...

Background Intimate partner violence (IPV) is a recognised risk factor for psychiatric disorders. There is little current evidence on IPV and self-harm and suicidality, and we therefore aimed to investigate the associations between experience of lifetime and past-year IPV with suicidal thoughts, suicide attempt, and self-harm in the past year. Met...

Objectives: SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the...

Objectives: SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive...

Purpose Prisoners experience extremely high rates of psychiatric disturbance. However, ex-prisoners have never previously been identified in representative population surveys to establish how far this excess persists after release. Our purpose was to provide the first community-based estimate of ex-prisoners’ mental health in England using the data...

[This corrects the article DOI: 10.1016/j.ssmph.2021.100858.].

Background The SlowMo study demonstrated the effects of SlowMo, an eight‐session digitally supported reasoning intervention, on paranoia in a large‐scale randomized‐controlled trial with 362 participants with schizophrenia‐spectrum psychosis. Aim The current evaluation aimed to investigate the impact of Patient and Public Involvement (PPI) in the...

Purpose Knife carrying has caused considerable public concern in the UK. But little is known of the epidemiology and characteristics of men who carry knives. We investigated associations with socioeconomic deprivation, area-level factors, and psychiatric morbidity. Methods Cross-sectional surveys of 5005 British men, 18–34 years, oversampling Blac...

Background: Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the...

Background Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce paranoia. Objectives To examine the effectiveness of SlowMo therapy in reducing paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanis...

Purpose Threatening or obscene messaging is repeated, unwanted texts, emails, letters or cards experienced by the recipient as threatening or obscene, and causing fear, alarm or distress. It is rarely examined as an aspect of intimate partner violence. We describe the prevalence of exposure to threatening/obscene messaging from a current or ex-part...

Background Schizophrenia is associated with premature mortality, partly through increased suicide rates. Aims To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective f...

Background Glasgow, Scotland, has previously shown exceptional levels of violence among young men, shows aggregations of health conditions, with shortened life expectancy. Health conditions can be both causes and consequences of violence, of shared community-level socio-economic risk factors, and can result from large-scale social forces beyond the...

Background Scotland has the shortest life expectancy in Western Europe, driven by high rates of cancer, suicides, alcohol-related causes and drug-related poisonings. These disparities cannot be explained solely by socioeconomic deprivation. Our aim was to investigate whether a syndemic in a socioeconomically deprived area of Glasgow might account f...

BACKGROUND SlowMo is a digitally supported therapy for paranoia that was developed using inclusive, human-centred design to improve outcomes and address barriers to implementation. SlowMo significantly improved paranoia and wellbeing compared to treatment as usual in a recent randomised controlled trial of 362 people with psychosis. OBJECTIVE This...

Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the "digital divide." Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimiz...

Importance Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. Objective To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared...

Background The number of antipsychotic prescriptions dispensed annually in England has increased substantially over the past decade. It is not known whether this is due to changes in prescribing practices, or an increase in the prevalence of psychosis. To our knowledge, no previous studies have investigated temporal trends in prevalence of psychoti...

Background: To date, the lifetime prevalence of Bipolar Disorder (BD) and BD patients’ access to mental health care in England has not been systematically studied. Methods: We used data from the Adult Psychiatric Morbidity Survey 2014 (N=7546). The Mood Disorders Questionnaire (MDQ) was used to screen for BD. Associations between sociodemographic...

Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically...

Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically...

Background: Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated by these factors. Aims: We investigated whether disparities are better explained by interactions between individual risk factors and place-base...

Mental health problems are often said to affect one in four people in Britain, although with no consistent explanation of what the figure includes. We used three English national population surveys of psychiatric morbidity from 2000, 2007 and 2014 to provide prevalence rates for recent psychiatric problems. We combined disorders progressively to de...

Purpose: Hearing and visual impairment have been associated with psychosis. Mechanisms behind this are poorly understood. We tested whether i) self-reported hearing and visual impairments are associated with psychotic symptoms in the 2014 UK Adult Psychiatric Morbidity Survey; ii) the odds of having psychotic symptoms vary with self-perceived degr...

Background The number of people presenting to hospital emergency departments after self-harming has increased in England. However, most people who self-harm do not present to hospitals, so whether this rise reflects an increase in the prevalence of self-harm in the community is unknown. Also unknown is whether the prevalence of non-suicidal self-h...

Purpose To investigate to what extent mental health treatment needs are met in white and black and minority ethnic (BME) prisoners. Methods Treatment needs of a random sample of male (n = 197) and female (n = 171) prisoners were assessed with standardised instruments. Interventions provided were confirmed through face-to-face interviews and case n...

Aims First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver out...

Background The interaction between positive, negative and depressive symptoms experienced by people with schizophrenia is complex. We used longitudinal data to test the hypothesis that depressive symptoms mediate the links between positive and negative symptoms. Methods We analyzed data from the European Schizophrenia Cohort, randomly sampled from...

Background Impulsivity may be an important risk factor in terms of future self-harm. However, the extent of this, whether it may relate to self-harm that is new in onset and/or repetition of self-harm, and the detail of any interaction with mood instability (MI) and childhood sexual abuse (CSA) requires detailed examination. Aims We used the 2000...

Background: Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. Objective: This study...

The Department of Health and Social Care (DHSC) commissioned the National Centre for Social Research, University College London, and Leicester University to undertake analysis of Adult Psychiatric Morbidity Survey (APMS) data to profile the circumstances of people with borderline intellectual impairment. APMS is one of the most authoritative and co...

The Department of Health and Social Care (DHSC) commissioned the National Centre for Social Research, University College London, and Leicester University to undertake analysis of Adult Psychiatric Morbidity Survey (APMS) data to profile the circumstances of people with borderline intellectual impairment. APMS is one of the most authoritative and co...

Background: Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identi...

BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study ai...

Background Non-psychotic affective symptoms are important components of psychotic syndromes. They are frequent and are now thought to influence the emergence of paranoia and hallucinations. Evidence supporting this model of psychosis comes from recent cross-fertilising epidemiological and intervention studies. Epidemiological studies identify plaus...

Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were sear...

Background: Cannabis use in young people is common and associated with psychiatric disorders. However, the prospective link between cannabis use and bipolar disorder symptoms has rarely been investigated. The study hypothesis was that adolescent cannabis use is associated with hypomania in early adulthood via several potential etiological pathways....

Background: Cannabis use in young people is common and associated with psychiatric disorders. However, the prospective link between cannabis use and bipolar disorder symptoms has rarely been investigated. The study hypothesis was that adolescent cannabis use is associated with hypomania in early adulthood via several potential etiological pathways...

Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: first...

Lifetime prevalence of psychotic disorders varies widely across studies. Epidemiological surveys have rarely examined prevalences of specific psychotic disorders other than schizophrenia, and the majority used a single-phase design without employing clinical reappraisal interview for diagnostic verification. The current study investigated lifetime...

Purpose: Public health psychiatry has a key role in violence prevention. Cross-national comparisons of violence and associated psychiatric morbidity can indicate targets for preventive interventions. Method: Data on young adult men in households, 18-34 years, were drawn from the Second Men's Modern Lifestyles survey in Great Britain (n = 2046) a...

Gambling problems are prevalent in the UK, especially in the most deprived boroughs of the country. Individual-level characteristics may exist alongside a social and geographical gradient. The study aimed to establish whether living in specific geographic areas increases problem gambling likelihood. It used data from the 2007 Adult Psychiatric Morb...

Modern psychiatric epidemiology researches complex interactions between multiple variables in large datasets. This creates difficulties for causal inference. We argue for the use of probabilistic models represented by directed acyclic graphs (DAGs). These capture the dependence structure of multiple variables and, used appropriately, allow more rob...

Borderline intellectual functioning (BIF) is associated with several neuropsychological deficits. We used national data to establish the prevalence of psychosis and psychotic symptoms, and the role of potential mediators. The BIF group were more than twice as likely to have probable psychosis (adjusted odds ratio (OR) = 2.3, 95% CI 1.4-4.0) and to...

Delusion is central to the conceptualization, definition, and identification of schizophrenia. However, in current classifications, the presence of delusions is neither necessary nor sufficient for the diagnosis of schizophrenia, nor is it sufficient to exclude the diagnosis of some other psychiatric conditions. Partly as a consequence of these cla...

This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the dia...

Background: High levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe h...

Background: In a companion paper, we established high levels of psychiatric morbidity in prisoners (Bebbington et al. Soc Psychiatry Psychiatr Epidemiol, 2016). In the current report, we evaluate how this morbidity translates into specific needs for treatment and the consequent implications for services. Mental health treatment needs and the exten...

Background Mental health professionals increasingly carry out risk assessments to prevent future violence by their patients. However, there are problems with accuracy and these assessments do not always translate into successful risk management. Objectives Our aim was to improve the accuracy of assessment and identify risk factors that are causal...

Background Anxiety disorders are prevalent yet under-recognized in late life. We examined the prevalence of anxiety disorders in a representative sample of community dwelling older adults in Hong Kong. Method Data on 1,158 non-demented respondents aged 60–75 years were extracted from the Hong Kong Mental Morbidity survey (HKMMS). Anxiety was asses...

Background: There is growing risk from terrorism following radicalisation of young men. It is unclear whether psychopathology is associated. Aims: To investigate the population distribution of extremist views among UK men. Method: Cross-sectional study of 3679 men, 18-34 years, in Great Britain. Multivariate analyses of attitudes, psychiatric...

Background: Despite high rates of mental health problems, there have been few studies of psychosis in people with borderline intellectual functioning. Aims: To use national survey data to establish the relative prevalence of hallucinations, persecutory ideation and psychosis in individuals with borderline intellectual functioning, and to examine th...

Common mental disorders (CMDs) comprise different types of depression and anxiety. They cause marked emotional distress and interfere with daily function,but do not usually affect insight or cognition. Although usually less disabling than major psychiatric disorders, their higher prevalence means the cumulative cost of CMDs to society is great. The...

Comorbidity refers to the presence of two or more conditions at the same time. In the 2007 report in this series, comorbidity between mental disorders was examined. In this chapter comorbidity across mental disorders, chronic physical conditions, psychological wellbeing and intellectual impairment is profiled. • Physical health conditions were meas...

In this chapter reported use of psychotropic medication and psychological therapy are examined, as well as the extent of use of health care services for a mental health reason (GP, inpatient and outpatient health care) and day and community service use. It should be noted that rates presented are based on participant self-reports, not health record...

Insomnia is common in people experiencing psychosis. It has been identified as a contributory cause of paranoia, but any causal relationship with hallucinations has yet to be established. We tested the hypotheses that insomnia i) has a cross-sectional association with hallucinations ii) predicts new inceptions of hallucinations and iii) that these...

Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, in...

Background: The National Psychiatric Morbidity Surveys include English cross-sectional household samples surveyed in 1993, 2000 and 2007. Aims: To evaluate frequency of common mental disorders (CMDs), service contact and treatment. Method: Common mental disorders were identified with the Clinical Interview Schedule - Revised (CIS-R). Service c...

Purpose: Binge drinking (BD) is common among young people. E-Health apps are attractive to them and may be useful for enhancing awareness. We aimed to investigate the impact of a publicly available evidence-based e-Health app (Digital-Alcohol Risk Alertness Notifying Network for Adolescents and Young Adults [D-ARIANNA]), estimating current risk of...

Insomnia is common in people experiencing psychosis. It has been identified as a contributory cause of paranoia, but any causal relationship with hallucinations has yet to be established. We tested the hypotheses that insomnia i) has a cross-sectional association with hallucinations ii) predicts new inceptions of hallucinations and iii) that these...

Little is known about the correlates of comorbid drug and alcohol dependence in people with schizophrenia outside the USA. We tested hypotheses that dependence on alcohol/drugs would be associated with more severe symptoms, and poorer psychosocial functioning and quality of life. The EuroSC Cohort study (N=1204), based in France, Germany and the UK...

Background: Antisocial personality disorder (ASPD) is strongly associated with violence but the effects of other personality disorder (PD) categories are uncertain. Purpose: To investigate associations between 10 DSM-IV PD categories and effects of co-occurring disorders on self-reported violence. Method: Cross-sectional survey of 8397 adults aged...

There is controversy whether associations between psychosis and violence are due to coexisting substance misuse and factors increasing risk in nonpsychotic persons. Recent studies in clinical samples have implicated independent effects of paranoid delusions. Research findings suggest that individual psychotic-like-experiences on the psychosis conti...

The persisting burden of psychiatric disorder - Volume 25 Issue 1 - Paul E. Bebbington

Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England. We us...

Despite both having some shared features, evidence linking psychosis and adult Attention Deficit Hyperactivity Disorder (ADHD) is sparse and inconsistent. Hypotheses tested were 1] adult ADHD symptoms are associated with auditory hallucinations, paranoid ideation and psychosis 2] links between ADHD symptoms and psychosis are mediated by prescribed...

BACKGROUND Bullying, an aversive experience with both short and long term consequences, is currently incorporated in bio-psychosocial models of psychosis. We used British national survey data to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis, and predicts the later emergence of paranoia ideati...

Being bullied is an aversive experience with short-term and long-term consequences, and is incorporated in biopsychosocial models of psychosis. We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis, and predicts the later em...