Tirril Harris

King's College London | KCL · Department of Health Service and Population Research

Background Many male prison leavers have significant mental health problems. Prison leavers often have a history of trauma, ongoing substance misuse and housing insecurity. Only a minority of prison leavers receive mental health care on release from prison. Objectives The aim of the Engager research programme was to develop and evaluate a theory-...

Background Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. Aims This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. Method The design is a parallel randomised superiority tria...

Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case stud...

Background Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotiona...

Abstract Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with with homelessness and substance misuse. Only a minority receive specialist mental health care, including on release from prison. Few theoretically informed interventions have been developed to address th...

Psychotherapists continue to be wary of researchers who enter the clinical domain and their methodologies, which can seem opaque and alien to clinical practice. The following is a report on a pilot project, supported and enabled through the Practice Research Network of the UK Council for Psychotherapy (UKCP), to explore whether adopting the role of...

Background: Following up released prisoners is demanding, particularly for those prisoners with mental health problems, for whom stigma and chaotic lifestyles are problematic. Measurement of mental health outcomes after release is challenging. To evaluate mental healthcare for offender populations, using high-quality randomised controlled trials,...

Background Both childhood maltreatment and insecure attachment are known to be associated with depression in adulthood. The extent insecure attachment increases the risk of adult clinical depression over that of parental maltreatment among women in the general population is explored, using those at high risk because of their selection for parental...

Introduction: The 'Engager' programme is a 'through-the-gate' intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention. Methods and analysis: The study is a parallel two-group random...

Background Rates of common mental health problems are much higher in prison populations, but access to primary care mental health support falls short of community equivalence. Discontinuity of care on release is the norm and is further complicated by substance use and a range of social problems, e.g. homelessness. To address these problems, we work...

Background Depression and debt are common in the UK. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer) aimed to assess the clinical effectiveness and cost-effectiveness of the addition of a primary care debt counselling advice service to usual care for patients with depression and debt. However...

A small-scale consultation of care leavers in South London was undertaken in 2013–2014, in order to inform a pilot mentoring scheme to reduce depression in young women through supporting their transition from care to independence. Research on the social factors implicated in the onset and course of depression indicates that social support during st...

Background: Psychological models of conversion disorder (CD) traditionally assume that psychosocial stressors are identifiable around symptom onset. In the face of limited supportive evidence such models are being challenged. Method: Forty-three motor CD patients, 28 depression patients and 28 healthy controls were assessed using the Life Events...

We test the hypothesis that the functional Val66Met polymorphism of BDNF interacts with recent life events to produce onset of new depressive episodes. We also explore the possibility that the Met allele of this polymorphism interacts with childhood maltreatment to increase the risk of chronic depression. In a risk-enriched combined sample of unrel...

Introduction The notion of life events adversely affecting health is deeply embedded in popular consciousness. However among theorists there have been interesting variations. Some early thinkers pursued general theories involving homeostasis, viewing disease in terms of ‘illness as a whole’. The best known were Cannon’s (1932) fight–flight reaction...

Depression frequently involves disrupted interpersonal relationships, while treatment with serotonergic anti-depressants can interfere with libido and sexual function. However, little is known about how serotonin activity influences appraisals of intimate partnerships. Learning more could help to specify how serotonergic mechanisms mediate social i...

Background: Key questions about the interaction between the serotonin transporter length polymorphism (5-HTTLPR) and stress in the etiology of depression remain unresolved. We test the hypotheses that the interaction is restricted to childhood maltreatment (as opposed to stressful events in adulthood), and leads to chronic depressive episodes (as...

Common genetic variants, such as the brain-derived neurotrophic factor (BDNF) Val/66/Met polymorphism (rs6265), are known to interact with environmental factors such as early adversity to increase the risk of subsequent major depression. Much less is known about how they interact with individual differences in cortisol, although these also represen...

Background Current NICE depression guidelines recommend a period of ‘active monitoring’ prior to commencing treatment with antidepressants. The content of consultations during active monitoring or supportive care has not been previously prescribed. Methods As part of a randomised trial of supportive care versus supportive care plus SSRI consultati...

Previous research has found an inverse cross-sectional relationship between an individual's access to social capital (defined as resources embedded within social networks) and depression, but this relationship has not been rigorously tested in prospective research. This is the first longitudinal study to evaluate the effect of social capital on the...

Close supportive relationships protect against psychological disorders and also facilitate recovery. However, little is known about the neurochemical mechanisms that mediate these effects. Variation in serotonin function influences affiliative behavior in humans and nonhuman primates. Here, we used tryptophan depletion in healthy adults to investig...

To investigate the feasibility and effectiveness of a needs-led, community-based intervention for treating individuals from black minority ethnic (BME) groups with common mental disorders. Forty eligible individuals from BME groups were randomised to a needs-led package of care (therapy based on the principles of cognitive behaviour therapy and eth...

The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored. In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12-19) two social indices of aversive experience were developed on the basis of prior research. First, the Life Events and Difficulties...

To determine (1) the effectiveness and cost-effectiveness of selective serotonin reuptake inhibitor (SSRI) treatment plus supportive care, versus supportive care alone, for mild to moderate depression in patients with somatic symptoms in primary care; and (2) the impact of the initial severity of depression on effectiveness and relative costs. To i...

This article is a retrospective review of the three volumes of Bowlby's trilogy, Attachment and Loss, where he set out his revolutionary view of attachment as the dominant drive behind human behaviour. Harris discusses the impact this has had on psychological thinking, in particular on ideas about mourning, and the connection with Darwinian evoluti...

Studies of the interaction of the serotonin transporter genotype and environment upon adult depression (G x E) have suggested a role for both childhood maltreatment and stressful life events. This paper deals with two main issues. First, do both contribute? Evidence that G x E with childhood maltreatment plays a role is much stronger than that for...

This is the final paper of a series concerning parental maltreatment and chronic depression in women. It extends the scope of the analysis to take account of proximal risk factors, present within at most six months of an onset. It deals with the contribution of factors influencing onset of a depressive episode as well as those related to whether th...

This fourth paper of a series of five concerning depression in women considers: i. why parental maltreatment increases risk of highly aversive ('very poor') partnerships, and ii. how far these relationships explain the link of such maltreatment with adult chronic depression. Data was collected retrospectively by semi-structured interviews and only...

Childhood maltreatment among women is related to risk of adult depression and particularly an episode taking a chronic course. This paper explores the aspects of parental behaviour involved. An expanded version of CECA (Childhood Experiences of Care and Abuse), a retrospective interview-based instrument covering neglect as well as various forms of...

Background: An earlier paper [Brown, G.W., Craig, T.K.J., Harris, T.O., Handley, R.V., Harvey, A.L., 2007a-this issue. Development of a retrospective interview measure of parental maltreatment using the Childhood Experience of Care & Abuse (CECA) instrument - a life-course study of adult chronic depression - 1. J. Affect. Disord. doi:10.1016/j.jad...

A previous paper, using data collected retrospectively from sister pairs, reported substantial associations of adult depressive episodes lasting at least 12 months with childhood maltreatment [Brown, G.W., Craig, T.K.J., Harris, T.O. Handley, R.V. & Harvey, A.L. 2007a-this issue. Development of a retrospective interview measure of parental maltreat...

abstract One notable aspect of femininity is the two-fold higher rate of depression among women. This paper outlines bio-psychosocial models of depression and draws on studies of depressive disorder directly comparing men and women. It is suggested that the finding of consistently higher rates of negative self-evaluation among women may be linked t...

Epidemiological differences in rates of mood disorders – higher prevalence among females and those of lower socioeconomic status – can be traced to intermediate psychosocial processes such as stressful life events. Greater vulnerability to such stressors has been traced to lack of support in responding to these, both currently in adulthood and in c...

John Bowlby's Attachment Theory is being increasingly operationalised in the world of developmental research, but as yet its implications for clinical work are relatively less discussed. This paper addresses the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts' work with their patients. It looks a...

Despite an acknowledgement of the impact of serious mental disorders on informal caregivers, we still know little about how to best help them. The aim of the study was to evaluate the effectiveness of a two-phased carers' intervention comprising family sessions followed by relatives' groups. This intervention was designed to be of 'intermediate' in...

The caregiving experience has been conceptualised as distress or satisfaction attributed to various factors in the carer's external and internal world. The aim of this study was to test how such factors relate to one another in the framework of a 'stress-coping' model using data from a group of carers of people with psychosis. Standard univariate a...

The biological mechanism by which social support influences the course of a depressive episode may involve the stress response which is reflected and/or mediated by cortisol. The study took advantage of the weekend leave that inpatients receive towards the end of an admission to investigate the inter-relationship between social support, cortisol se...

Recent advances in the psychosocial understanding of depression have elaborated an already complex aetiological model. Yet each new strand seems to echo, and forge links with, themes uncovered earlier, making it easier to see what is common about the 'final common pathway' to onset. For example, although recent stressors have for some time been rec...

Whether individual differences in cortisol contribute to subsequent major depressive disorder (MDD) is unknown. To determine whether premorbid levels of salivary cortisol and dehydroepiandrosterone (DHEA) were associated with subsequent MDD and how these related to psychosocial factors known to increase the risk for MDD. Adult women (n=116) were re...

To examine the relationship between stressful life events and alterations in glycemic control in adults with diabetes. The occurrence of stressful experiences was recorded using the life Events and Difficulties Schedule of Brown and Harris in 55 adults with type 1 diabetes. The two most recent measures of glycemic control (HbA1c) were obtained from...

Earlier work on the protective role of social support in onset and course of depressive disorder suggested that its provision might be relevant for outcome. To evaluate volunteer befriending as an intervention among women with chronic depression in inner London. A randomised controlled trial, with a waiting list control design, with outcome measure...

Volunteer befriending promoted remission of chronic depression when clinical and other treatment variables were controlled. To examine the role of other psychosocial factors relevant for outcome. Factors measured at baseline interview were examined in multivariate analyses along with psychosocial factors occurring during follow-up, such as 'fresh-s...

Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a popul...

Research in the past year on psychosocial antecedents of depression has highlighted the importance of interpersonal factors, among which distal interpersonal experiences in childhood are increasingly becoming a focus of attention. It is worth noting that the social meanings of these early experiences are often paralleled by more recent experiences...

Responds to comments by R. Langs and A. Badalamenti (see record 1996-02365-001) concerning T. Harris's (see record 1995-18465-001) comments on the modeling of a formal science of psychoanalysis proposed by Langs and Badalamenti (see record 1995-18479-001). It is suggested that Langs and Badalamenti were unclear in communicating their meaning, as...

Synopsis This paper is part of a series dealing with the role of life events in the onset of depressive disorders. Women who developed depression in a general population sample in Islington in North London are contrasted with a National Health Service-treated series of depressed patients in the same area. Findings among the latter confirm the impor...

The development of a retrospective, investigator-based interview measure of Childhood Experience of Care and Abuse (CECA) used with two community samples of adults in London is described. The component ratings are shown to have satisfactory inter-rater reliability and also validity as determined by agreement between sisters' independent accounts. T...

We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients. A consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were intervie...

Research has failed to find the expected clear-cut difference in the presence of events provoking onset in endogenous and nonendogenous depression. A longitudinal study of 127 depressed female patients from two psychiatric departments were studied using the Present State Examination and the Life Event and Difficulty Schedule. Two earlier patient se...

Synopsis A survey of an inner-city population of working-class and single mothers is described and the prevalence of anxiety and depression reported using two related diagnostic schemes, Bedford College caseness and DSM-III-R. This acts as an introduction to an analysis which indicates that adverse experiences in childhood and adolescence (involvin...

Synopsis An earlier paper documented that adverse experiences in childhood and adolescence considerably raise risk of both depressive and anxiety conditions (with the exception of mild agoraphobia and simple phobia) in adult life. This paper deals with the same inner-city women with children at home. Consideration of adverse experiences throughout...

"The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small,...

Two population enquiries in Walthamstow and Islington, London, have shown that loss of the mother before the age of 17 years, either by death or separation for a year or more, doubles the risk of depressive and anxiety disorders among adult women. Furthermore, there was a particularly high rate of adult depression among those whose mothers died bef...

social support and clinical depression: a theoretical model / the nature of supportive and unsupportive behaviors / further concrete examples (PsycINFO Database Record (c) 2012 APA, all rights reserved)

This volume focuses on methods of data treatment, emphasising the importance of careful matching of methodology to the substantive problem under consideration. It deals particularly with concepts of stability and change which are central to personality and developmental research. Contributions to this volume explore the methodology and scope of lif...

Examines the hypothesis that specific disorders arise from specific psychosocial circumstances by using the life event and difficulty schedule (LEDS). The LEDS focuses on associations between life events and the occurrence of depressive states, and the measurement of the meaning of stressful experiences. The LEDS was used in studies of depression,...

This paper continues the investigation of differential states of depression in a sample of 225 women selected for different experiences of parental loss in childhood by introducing a measure of the cognitive-behavioural set of situational helplessness/mastery which uses actual rather than hypothetical situations as the basis for scoring. The measur...

Two previous reports on a female population sample in Outer London, UK, had identified certain environmental experiences–such as lack of adequate replacement care after parental loss in childhood, premarital pregnancy, and low social class and poor emotional support in adulthood–as key factors intervening between childhood loss of parent and depres...

Information was obtained on stressful life circumstances, using the Life Events and Difficulties Schedule (LEDS) from 39 patients with early multiple sclerosis and 40 matched nonpatient volunteers. The proportion of multiple sclerosis patients who experienced marked life adversity in the year prior to onset of symptoms was significantly higher than...

Bebbington (1986) draws attention to a possible cause for concern regarding the comparability of recent epidemiological research utilising the PSE-ID-CATEGO system of psychiatric caseness deter mination. In taking issue with our observation that cases in our recent community survey (Brown et al, 1985) were broadly similar in terms of severity to th...

Synopsis This paper addresses the critique which maintains that loss of parent in a sample of female adults plays no role in determining current depression over and above that of low social class position with which such loss is associated. It examines a series of variables which combine to determine current social class position and which seem to...

A study of women living in Islington has confirmed earlier findings that the loss of a mother before the age of 17 (by death or separation) is associated with an increase in clinical depression in adulthood. Lack of adequate parental care following the loss accounted for the increase in disorder and there was some evidence that it acted as a 'vulne...

A prospective study of 400 largely working-class women with children living at home has once again demonstrated the major importance of long-term severe threatening life events in provoking caseness of depression. However, it again shows that only about one out of five women experiencing such an event go on to develop depression at a case level. Th...

Synopsis A prospective study of 400 largely working-class women with children living at home has used measures of self-esteem and ‘social support’ to predict the risk of depression in the following year once a stressor had occurred. Actual support received at the time of any crisis in the follow-up year was also measured. Self-esteem was correlated...

Synopsis The inconclusiveness of the literature on the role of loss of parent in influencing psychiatric disorder in adulthood is well known. A number of reasons involving sampling, location and other methodological features, are given to account for these contradictory findings. A study specially designed to cope with these features is then descri...

Prospective enquiries of the role of social factors in the aetiology of depression are faced with the problem of who to exclude from the enquiry in terms of psychiatric symptomatology present at first contact. With this problem in mind the role of subclinical symptoms among women not cases of depression has been examined in terms of their relation...

Surveys using clinical-type interviews have documented a high rate of depression among working-class women, and this is discussed in the light of a recent survey in an inner-city area. While women with caseness of depression contacting a psychiatrist did not differ in number of core depressive symptoms from those who did, they did in certain charac...