Rob Saunders

University College London | UCL · Department of Clinical, Educational and Health Psychology

Background A significant rise in mental health disorders was expected during the COVID-19 pandemic. However, referrals to mental health services dropped for several months before rising to pre-pandemic levels. Aims To identify trajectories of incidence and risk factors for common mental disorders among the general population during 14 months of th...

Purpose There are discrepancies in mental health treatment outcomes between ethnic groups, which may differ between genders. NHS Talking Therapies for anxiety and depression provide evidence-based psychological therapies for common mental disorders. This study examines the intersection between ethnicity and gender as factors associated with psychol...

Background: Sleep disturbance is a common symptom of depression. There is conflicting evidence whether improvements in sleep might impact depressive symptoms, or whether treating the core depressive symptoms might improve sleep disturbance. This study explored the bi-directional impact of sleep and depressive symptom change among individuals recei...

Background Prior research has highlighted that people living with dementia experiencing depression or anxiety can benefit from psychological therapies delivered in primary care. Yet, studies have mainly focused on common dementia types, leaving a gap in evidence for more atypical dementias, and especially those that are not memory‐led. This evaluat...

Background Psychological therapies are recommended for people living with dementia who experience depression or anxiety. However, people living with dementia often experience specific barriers to accessing services providing such interventions, notably due to the stigma associated with dementia. This study sought to understand pathways to entering...

Background Psychological factors such as repetitive negative thinking, proneness to experience distress, and perceived stress are associated with increased risk of neurodegeneration and clinical dementia, whereas having a sense of life‐purpose, self‐reflection, and dispositional mindfulness may be protective. However, whether combinations of these...

Psychological characteristics are associated with varying dementia risk and protective factors. To determine whether these characteristics aggregate into psychological profiles and whether these profiles differentially relate to aging health, we conducted a cross-sectional investigation in two independent middle-aged (51.4 ± 7.0 years (mean ± s.d.)...

Epistemic trust ‐ defined as readiness to regard knowledge, communicated by another agent, as significant, relevant to the self, and generalizable to other contexts–has recently been applied to the field of developmental psychopathology as a potential risk factor for psychopathology. The work described here sought to investigate how the vulnerabili...

The prevalence of common mental disorders (CMDs) such as depression and anxiety disorders is increasing, with depression now the leading cause of disabilities globally, meaning that governments must take decisive actions to finance evidence-based support for these conditions. Psychological therapies, such as cognitive–behavioural therapy (CBT), are...

Background Resilience is a crucial factor in students’ mental health, playing an important role in their successful adaptation to the academic environment. However, there is a lack of understanding about resilience and its associated factors in students from different undergraduate courses. This study aimed to describe the resilience profile of und...

Background Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depre...

INTRODUCTION People with dementia may benefit from psychological therapies for depression or anxiety, but evidence of their effectiveness in atypical dementia is limited. METHODS Using electronic health‐care records of > 2 million people who attended psychological therapy services in England between 2012 and 2019, we examined pre–post therapy symp...

Introduction Accurate prediction of short-term offending in young people exhibiting antisocial behaviour could support targeted interventions. Here we develop a set of machine learning (ML) models that predict offending status with good accuracy; furthermore, we show interpretable ML analyses can complement models to inform clinical decision-making...

Introduction Attendance at university can result in social support network disruption. This can have a negative impact on the mental health of young people. Demand for mental health support continues to increase in universities, making identification of factors associated with poorer outcomes a priority. Although social functioning has a bi-directi...

Background Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experi...

Introduction Shared Decision Making (SDM) is a health communication model that promotes patient- cantered care that is not routinely used in mental health. This is partly because none of the existing SDM measures have been co-produced with people with mental illness and their families, and there is no consensus on outcomes as primary targets of SDM...

Introduction Shared Decision Making (SDM) is a health communication model promoting patient- centred care that is not routinely utilised in mental health. Inconsistent definitions, models, measures, and the lack of sufficient evidence for the effectiveness of SDM interventions could explain the limited use of SDM in mental health. This umbrella rev...

Background Autistic people are disproportionately likely to experience premature mortality and most mental and physical health conditions. We measured the incidence of diagnosed conditions accounting for the most disability-adjusted life years in the UK population according to the Global Burden of Disease study (anxiety, depression, self-harm, harm...

Aims Hyperglycaemia aversion in type 1 diabetes can be associated with severe hypoglycaemia and impaired awareness of hypoglycaemia but is not routinely assessed clinically. This study aimed to undertake the first psychometric validation of the UK version of the Hyperglycaemia Avoidance Scale (HAS‐UK). Methods The HAS‐UK was completed by adults wi...

Background: There is heterogeneity in long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where most patients seek treatment....

Autistic people are more likely than non-autistic people to experience mental health difficulties. The Strengths and Difficulties Questionnaire is often used to screen for these difficulties and to otherwise make important decisions about mental health treatment and research in populations of autistic people. However, this study suggests that paren...

Background The escalating prevalence of mental health issues among university students is alarming, particularly as many do not receive necessary mental health interventions. While existing qualitative research has shed light on the perceived barriers students face accessing mental health care, our study explored the experiences of healthcare profe...

Objectives In order to develop a better understanding of students’ access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods We interviewed 23 professionals working across university advice and counselling services, NHS general practice, cris...

Aims: Previous research has established a relationship between self-management and better emotional health. However, self-management has not been explored amongst LGBTQ+ adolescents, who are more likely to have a mental health difficulty than their non-LGBTQ+ peers, but less likely to access specialist mental health services. Furthermore, self-mana...

Background Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. Aims To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLW...

Background Feelings of emptiness are commonly reported as deeply distressing experiences. Despite established relationships between emptiness and many mental health difficulties, alongside self-harm and suicide, further study into this phenomenon has been restricted by vague definition and clinical measures with limited utility. Recently the first...

Background Primary care psychological therapy services can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD) and are recommended in national guidelines (e.g., NICE, UK). However, it is currently unknown which factors are associated with better psychological therapy outcomes in PLWD. Method National l...

Background Positive and negative psychological factors represent pertinent moderators of relative risk and protection for cognitive decline and dementia. For example, repetitive negative thinking has been associated with accelerated cognitive decline and AD pathology ¹ , whereas self‐reflection and purpose in life have been related to better cognit...

Background Depression and anxiety are well recognised as risk factors for dementia and poorer cognitive outcomes. However, considerably less is known about the relationship between quality of life and cognitive function over time. Quality of life is not simply the absence of mental health problems, but instead is a related but distinct construct. I...

Objective: to examine whether an underlying general psychopathology factor (p factor) existed in children and adolescents attending psychodynamic psychotherapy and whether this general psychopathology factor was associated with family functioning and engagement with psychotherapy. Method: Participants were 1976 children and adolescents, and their f...

Background Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people...

Introduction Shared decision making (SDM) is a health communication approach focusing on patient-clinician interactions around treatment decisions, with the goals of improving clinical and functional outcomes and providing personalized care. Moreover, decision making may need to be negotiated between, and communicated to, multiple health and social...

Background: With many digital (mental) health interventions (DHI) failing to engage clients for enough time to demonstrate substantive changes to their wellbeing and with only 2% of all digital solutions on App Stores having undergone randomised controlled trials, the rising demand for mental health prevention and early intervention care is not bei...

Background: The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in t...

Background: Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level. Methods: Using a unique individua...

Summary Background Evidence suggests that culturally adapted psychological interventions have some benefits in treating diverse ethnic groups. However, the effect of such cultural adaptions specifically in Chinese ethnic groups has not been thoroughly reviewed. We aimed to systematically assess the evidence for the efficacy of different cultural ad...

Background The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalised Anxiety Disorder scale (GAD-7) scales are routinely used in research and clinical practice. Whilst measurement invariance of these measures across gender has been demonstrated individually in general population studies and clinical samples, less is known ab...

Aims: People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary c...

Background: Cognitive stimulation therapy (CST) is the only non-pharmacological, treatment for dementia recommended by the UK National Institute for Health and Care Excellence, following multiple international trials demonstrating beneficial cognitive outcomes in people with mild-to-moderate dementia. However, there is limited understanding of whe...

Background: Autism has long been viewed as a paediatric condition, meaning that many autistic adults missed out on a diagnosis as children when autism was little known. We estimated numbers of diagnosed and undiagnosed autistic people in England, and examined how diagnostic rates differed by socio-demographic factors. Methods: This population-ba...

Background: The transition to university and resultant social support network disruption can be detrimental to the mental health of university students. As the need for mental health support is becoming increasingly prevalent in students, identification of factors associated with poorer outcomes is a priority. Changes in social functioning have a...

Purpose: There are concerns that the social, economic and health impacts of COVID-19 are unevenly distributed, exacerbating existing inequalities. Here we tested the hypotheses that: (H1) the magnitude of these impacts would be associated with symptoms of depression and anxiety early in the pandemic, and (H2) that these impacts would be associated...

Background Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. Objectives This study aimed to identify whether CBT and CfD target different...

Background Dementia incidence is increasing across the globe and currently there are no disease-modifying pharmaceutical treatments. The Lancet Commission on dementia identified 12 modifiable risk factors which explain 40% of dementia incidence. However, whether these associations are causal in nature is unclear. Objective To examine the modifiabl...

Background Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental...

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little pr...

Background International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population ment...

Background: There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patient...

Background When experiencing mental distress, many university students seek support from their peers. In schools and mental health services, formalised peer support interventions have demonstrated some success but implementation challenges have been reported. This study aimed to assess the feasibility, acceptability and safety of a novel manualized...

Background Meta-analyses support an association between anxiety in older adulthood and dementia. The aim of this study was to use routinely collected health data to test whether treatment of anxiety disorders through psychological intervention is associated with a lower incidence of dementia. Methods In this prospective cohort study, data from nat...

Background Depression and anxiety disorders are increasingly prevalent among university students, making the provision of effective treatment in this population a priority. Whilst campus-based services provide some psychological treatments, many students are treated by routine adult psychological treatment services which have no focus or adaptation...

Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the con...

Aim To synthesise evidence regarding the association between positive psychological constructs (PPCs) and cognitive function in adults aged 50+. Methods Literature searches: Medline, PsycINFO, and Scopus (inception to February 2022). Studies were included if they reported on the association between at least one PPC and one objective measure of cog...

Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psycho...

Background Depression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological t...

Objectives We aimed to translate and culturally adapt Virtual Individual Cognitive Stimulation Therapy (V-iCST) for the Hong Kong (HK) Chinese population, and to evaluate its feasibility and acceptability. Methods A mixed methods case series (N=8) was used to assess the feasibility of V-iCST and changes in cognition, quality of life (QoL), mood, a...

Background: Cognitive Behavioural Therapy (CBT) and Counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently there is little understanding of the impact those approaches have on change during treatment. Objectives: This study aimed to identify whether CBT and CfD target different...

Psychotherapy is an effective treatment for many common mental health problems, but the mechanisms of action and processes of change are unclear, perhaps driven by the focus on a single diagnosis which does not reflect the heterogeneous symptom experiences of many patients. The objective of this study was to better understand therapeutic change, by...

Background: In the absence of disease-modifying treatments, identifying potential psychosocial risk factors for dementia is paramount. Depression and anxiety have been identified as potential risk factors. Studies however have yielded mixed findings, lending possibility to the fact that potential constellations of co-occurring depression and anxie...