Sania Shakoor’s research while affiliated with University of London and other places

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Publications (14)


Schematic diagram of multiple group structural equation model. SES, socioeconomic status. Intersectional profile (depicted at the center of the Venn diagram) is the grouping variable in the multiple group model, where all parameters inside the box are estimated separately for each intersectionality profile (e.g., the profile of female, lower SES, low hyperactivity/inattention). Compound parameters are estimated, reflecting the extent to which the individual characteristics (e.g., gender) and their intersections (labelled with superscript letters in the diagram: a) gender by hyperactivity/inattention, b) hyperactivity/inattention by SES, and c) gender by SES) moderate the path from youth adversity to the depression/anxiety latent factor. The five items of the Strengths and Difficulties Questionnaire emotional problems subscale are specified as indicators of the latent factor of depression/anxiety. The model depicted schematically in this figure provides the framework for addressing the research questions detailed in the Methods section.
The effect of youth adversity on depression/anxiety by intersectionality profiles. SES, socioeconomic status. Latent depression/anxiety scaled relative to the intercept for the male, higher SES, low hyperactivity/inattention intersectionality profile (mean‐centered at zero). Parameter estimates shown in Supporting Information S1: Supplementary Table 8.
A cross‐sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community
  • Article
  • Full-text available

May 2024

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64 Reads

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1 Citation

Laura Havers

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Kamaldeep Bhui

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[...]

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Sania Shakoor

Background Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association. Methods Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13–14‐year‐olds in Cornwall, United Kingdom in 2017‐2019. In a cross‐sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated. Results Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [−0.02,0.44]). Conclusions Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13–14‐year‐olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry.

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Figure 1. Schematic diagram of the multiple group conditional latent growth model. Note. SES: socio-economic status. Intersectional profile (depicted at the center of the Venn diagram, above left) is used as the grouping variable in a multiple group model, where everything inside of the box (above right) is estimated for each intersectionality profile group. Compound parameters are further estimated, reflecting the extent to which the individual characteristics, as well as the intersections between them (i.e. the shaded areas of the Venn diagram), moderate the paths from youth adversity to the latent growth factors. The observed depression/anxiety symptoms scores are indicators of the latent growth factors. A non-schematic, labeled path diagram is shown in online Supplementary Fig. 1.
Figure 2. Effect of youth adversity on average depression/anxiety symptoms trajectories by intersectionality profiles. Note. SES: socio-economic status. Y axis: depression/anxiety symptoms total observed score. School year corresponds to the following average ages: 11-12-years (Year 7), 12-13-years (Year 8), 13-14-years (Year 9).
Sample description
Compound parameter estimates of youth adversity as a predictor of the latent growth factors of depression/anxiety symptoms
Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom

April 2024

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63 Reads

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1 Citation

Psychological Medicine

Background Youth adversity is associated with persistence of depression and anxiety symptoms. This association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g. males). Given that persistent symptoms are observed across a range of disadvantaged, minoritized, and neurodivergent groups (e.g. low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. Methods Data from HeadStart Cornwall ( N = 4441) was used to assess the effect of youth adversity on combined symptoms of depression and anxiety (Strengths and Difficulties Questionnaire emotional problems subscale) measured at three time-points in 11–14-year-olds. Latent trajectories and regressions were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention), and moderating effects of the individual characteristics and their intersections were estimated. Results Youth adversity was associated with higher average depression/anxiety symptoms at baseline (11–12-years) across all intersectionality profiles. The magnitude of effects differed across profiles, with suggestive evidence for a moderating effect of youth adversity on change over time in depression/anxiety symptoms attributable to the intersection between (i) gender and SES; and (ii) gender, SES, and hyperactivity/inattention. Conclusions The detrimental effects of youth adversity pervade across intersectionality profiles. The extent to which these effects are moderated by intersectionality is discussed in terms of operational factors. The current results provide a platform for further research, which is needed to determine the importance of intersectionality as a moderator of youth adversity on the development of depression and anxiety symptoms in adolescence.


Perinatal risk factors and subclinical hypomania: a prospective community study

March 2024

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5 Reads

Background Perinatal risk factors are implicated in the development of psychopathology, but their role in bipolar disorder (BD) and hypomania is unclear. Using data from a prospective community cohort, this is the first study to investigate the association between a range of perinatal risk factors, hypomanic symptoms, and ‘high-risk’ for BD in the general population. Methods Parent report of perinatal events were available for 26,040 eighteen-month-olds from the Twins Early Development Study. Subsequent self-report hypomania was measured at ages 16 (Hypomania Checklist-16; N=2,943) and 26 (Mood Disorders Questionnaire; N=7,748). Participants were categorised as ‘high-risk’ for BD using established classifications. Linear and logistic regressions were conducted within a generalised estimating equations framework to account for relatedness in the sample. Results Prenatal alcohol exposure (β=0.08, SE=0.04, p=.0002) and number of alcohol units consumed (β=0.09, SE=0.02, p<.0001) were associated with hypomanic symptoms at age 16, and number of alcohol units (OR=1.13, 95% CI:1.06–1.21, p=.0003) and maternal stress (OR=1.68, 95% CI:1.21–2.34, p=.002) were associated with ‘high-risk’ for BD age 16. Prenatal tobacco exposure (β=0.10, SE=0.04, p<.0001) and number of cigarettes smoked (β=0.10, SE=0.01, p<.0001) were associated with hypomanic symptoms and ‘high-risk’ for BD at age 26, although these result were attenuated controlling for parental psychiatric history.LimitationsFamilial confounding could not be fully adjusted for. Rater reports include some biases.Conclusions These findings show perinatal risk factors to be associated with subclinical hypomania and ‘high-risk’ for BD. Future work should explore the mechanisms underlying these longitudinal associations, which could shed light on prevention and intervention efforts.



A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community

December 2023

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29 Reads

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1 Citation

Background: Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in disadvantaged (e.g., females, low socioeconomic status [SES]), as well as neurodivergent, groups. The intersection of these characteristics may moderate the impact of youth adversity on adolescent mental health.Aims: To investigate the moderating influence of intersectionality on the relation between youth adversity and depression and anxiety symptoms in adolescence.Methods: Depression and anxiety symptoms were measured in 13-14-year-olds in the HeadStart Cornwall cohort (N=12,067) using the emotional problems subscale of the Strengths and Difficulties Questionnaire. Multiple group structural equation modelling was used to estimate the effects of youth adversity on combined depression and anxiety symptoms across eight intersectionality profiles. Group assignment was based on gender (female/male), SES (lower/higher), and hyperactivity/inattention (high/low). Moderation effects attributable to these characteristics and their intersections were estimated.Results: Youth adversity was associated with higher levels of depression and anxiety (compared to an absence of youth adversity), across intersectional profiles. This association was moderated by gender (stronger in males than females (β=0.22 [0.11,0.36])), and SES (stronger in higher compared to lower SES (β=0.26 [0.14,0.40])); with indications of moderation attributable to the intersection of gender and hyperactivity/inattention (β=0.21 [-0.02,0.44]).Conclusions: Youth adversity detrimentally impacts the mental health of 13-14-year-olds, across intersectional profiles. Preliminary findings suggest that vulnerability and resilience to the negative impacts of youth adversity may partially depend on the intersection of individual characteristics. These results invite further investigation in this emerging field of research.


Racialised staff-patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data

October 2023

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56 Reads

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5 Citations

BMJ Mental Health

Background The current study is a secondary analysis of qualitative data collected as part of EURIPIDES, a study which assessed how patient experience data were used to improve the quality of care in National Health Service (NHS) mental health services. Objective We undertook a detailed realist secondary qualitative analysis of 10 interviews in which expressions of racialisation were unexpectedly reported. This theme and these data did not form part of the primary realist evaluation. Methods Interviews were originally conducted with the patients (18–65 years: 40% female, 60% male) from four different geographically located NHS England mental health trusts between July and October 2017. Secondary qualitative data analysis was conducted in two phases: (1) reflexive thematic analysis and retroduction; (2) refinement of context–mechanism–outcome configurations to explore the generative mechanisms underpinning processes of racialisation and revision of the initial programme theory. Findings There were two main themes: (1) absence of safe spaces to discuss racialisation which silenced and isolated patients; (2) strained communication and power imbalances shaped a process of mutual racialisation by patients and staff. Non-reporting of racialisation and discrimination elicited emotions such as feeling othered, misunderstood, disempowered and fearful. Conclusions The culture of silence, non-reporting and power imbalances in inpatient wards perpetuated relational racialisation and prevented authentic feedback and staff–patient rapport. Clinical implications Racialisation in mental health trusts reflects lack of psychological safety which weakens staff–patient rapport and has implications for authentic patient engagement in feedback and quality improvement processes. Larger-scale studies are needed to investigate racialisation in the staff–patient relationships.


Youth adversity and trajectories of depression and anxiety symptoms in adolescence in the context of intersectionality

October 2023

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247 Reads

Background: Youth adversity is associated with persistence of depression and anxiety symptoms over time. Evidence suggests that this association may be greater for disadvantaged societal groups (such as females) compared with advantaged groups (e.g., males). However, given that persistent symptoms are observed across a range of disadvantaged groups (e.g., low compared with high socio-economic status [SES]), the intersection of individual characteristics may be an important moderator of inequality. Methods: Data from HeadStart Cornwall (N=5,336) was used to assess the effect of youth adversity on symptoms of depression and anxiety, measured using the Strengths and Difficulties Questionnaire emotional problems subscale, at three time-points in 11-14-year-olds. Latent trajectories and regression coefficients were estimated for eight intersectionality profiles (based on gender, SES, and hyperactivity/inattention) within a multiple group structural equation model. Compound parameters were specified to estimate the moderating effects of the individual characteristics and their intersections. Results: Youth adversity, compared with an absence of such, was associated with higher average depression and anxiety symptoms at baseline (11-12-years), across all intersectionality profiles. The magnitude of the effect of youth adversity differed across profiles, and there was weak evidence to suggest that the effect of youth adversity on the average rate of change in depression and anxiety symptoms was moderated by the intersection of, i) gender and SES, and ii) gender, SES, and hyperactivity/inattention. Conclusions: Youth adversity has detrimental effects on the development of depression and anxiety symptoms that pervade across intersectionality profiles: The extent to which these effects are moderated by intersectionality are discussed in terms of operational factors and sample size. The current results provide a platform for further research, which is needed to determine whether intersectionality is important in moderating the effect of youth adversity on the development of depression and anxiety symptoms in adolescence.



Description of cohorts
Protocol for secondary data analysis of 4 UK cohorts examining youth adversity and mental health in the context of intersectionality

August 2023

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136 Reads

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2 Citations

Background Youth adversity (e.g., abuse and bullying victimisation) is robust risk factor for later mental health problems (e.g., depression and anxiety). Research shows the prevalence of youth adversity and rates of mental health problems vary by individual characteristics, identity or social groups (e.g., gender and ethnicity). However, little is known about whether the impact of youth adversity on mental health problems differ across the intersections of these characteristics (e.g., white females). This paper reports on a component of the ATTUNE research programme (work package 2) which aims to investigate the impact and mechanisms of youth adversity on depressive and anxiety symptoms in young people by intersectionality profiles. Methods The data are from 4 UK adolescent cohorts: HeadStart Cornwall, Oxwell, REACH, and DASH. These cohorts were assembled for adolescents living in distinct geographical locations representing coastal, suburban and urban places in the UK. Youth adversity was assessed using a series of self-report questionnaires and official records. Validated self-report instruments measured depressive and anxiety symptoms. A range of different variables were classified as possible social and cognitive mechanisms. Results and analysis Structural equation modelling (e.g., multiple group models, latent growth models) and multilevel modelling will be used, with adaptation of methods to suit the specific available data, in accord with statistical and epidemiological conventions. Discussion The results from this research programme will broaden our understanding of the association between youth adversity and mental health, including new information about intersectionality and related mechanisms in young people in the UK. The findings will inform future research, clinical guidance, and policy to protect and promote the mental health of those most vulnerable to the negative consequences of youth adversity.


Protocol for secondary data analysis of youth adversity and mental health in the context of intersectionality

July 2023

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143 Reads

Background: Youth adversity (e.g., abuse and bullying victimisation) is robust risk factor for later mental health problems (e.g., depression and anxiety). Research shows the prevalence of youth adversity and rates of mental health problems vary by individual characteristics, identity or social groups (e.g., gender and ethnicity). However, little is known about whether the impact of youth adversity on mental health problems differ across the intersections of these characteristics (e.g., white female). This paper reports on a component of the ATTUNE research programme (work package 2) which aims to investigate the impact and mechanisms of youth adversity on depressive and anxiety symptoms in young people by intersectionality profiles. Methods: The data are from 4 UK adolescent cohorts: HeadStart Cornwall, Oxwell, REACH, and DASH. These cohorts were assembled for adolescents living in distinct geographical locations representing coastal, suburban and urban places in the UK. Youth adversity was assessed using a series of self-report questionnaires and official records. Validated self-report instruments measured depressive and anxiety symptoms. A range of different variables were classified as possible social and cognitive mechanisms. Results and analysis: Structural equation modelling (e.g., multiple group models, latent growth models) and multilevel modelling will be used, with adaptation of methods to suit the specific available data, in accord with statistical and epidemiological conventions. Discussion: The results from this research programme will broaden our understanding of the association between youth adversity and mental health, including new information about intersectionality and related mechanisms in young people in the UK. The findings will inform future research, clinical guidance, and policy to protect and promote the mental health of those most vulnerable to the negative consequences of youth adversity.


Citations (8)


... The findings from such empirical studies demonstrate the importance of considering markers of disadvantage, like low SES, in the context of other characteristics. However, only one study to our knowledge has investigated the extent to which the intersection of multiple characteristics moderates the effect of youth adversity on mental health problems in youth (Havers et al., 2024). This study reported suggestive evidence to indicate differential effects of youth adversity on change over time in depression/anxiety symptoms for males and females dependent on SES and traits of hyperactivity/inattention. ...

Reference:

A cross‐sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community
Youth adversity and trajectories of depression/anxiety symptoms in adolescence in the context of intersectionality in the United Kingdom

Psychological Medicine

... This suggests that the contribution of the same PRSs to the development of PPD in the two conditions may be different, thus increasing the error when these factors are modelled together. This perspective is in agreement with recent findings showing that the genetic landscapes for the two disorders have different effects in influencing the gene-environment interaction preceding an illness episode [47], epigenetically active sites in immune cells [48], and several circulating biomarkers, including immune-inflammatory markers [49]. This observation suggests that the genetic contribution to PPD could involve different factors in the two disorders. ...

Interplay between polygenic risk for mood disorders and stressful life events in bipolar disorder
  • Citing Article
  • January 2024

Journal of Affective Disorders

... Analysis was repeated across the themes and allowed the development of context-mechanism-outcome configurations (CMOs). This two-step analytical approach aligns with previous research, allowing participants' narrative experiences to remain foremost while identifying the mechanisms that may drive outcomes 19,20 . ...

Racialised staff-patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data

BMJ Mental Health

... Recognizing that the theoretical and judicial origins of intersectionality are rooted in gender and race (Crenshaw, 1991), the current study makes use of available measures in an existing cohort study to explore intersectionality conceptualized more expansively (Cole, 2009) in terms of gender (binary), SES, and traits of hyperactivity/inattention (as an index of neurodivergence) in a representative sample of adolescents living in a rural/coastal region of the United Kingdom (Hosang et al., 2023). ...

Protocol for secondary data analysis of 4 UK cohorts examining youth adversity and mental health in the context of intersectionality

... Therefore, ELA and its perception may be more pronounced in older individuals. The usage of the CTQ itself reveals other limitations, although various studies confirm its consistency and reliability [45][46][47][48], e.g., a certain risk of retrospective bias, especially within patient groups [49,50]; the limited scope of other forms of adversity, such as childhood interpersonal trauma [51], are not captured; and the lack of context in terms of details of the frequency, duration or severity of adverse experiences [52]. ...

Reliability and convergent validity of retrospective reports of childhood maltreatment by individuals with bipolar disorder

Psychiatry Research

... As digital use by children and adolescents has exponentially increased over the past decade [17], the potential for digital health interventions is promising. The application of digital health technologies (DHTs) has the potential to assist in screening and mitigation of the profound impacts of early life experiences and improve the well-being of children and young people [18]. DHTs have been emerging as transformative solutions to challenges in health care delivery since the early 2000s and are considered to promote equitable, affordable, and universal access to patients and health care providers [19]. ...

Creative arts and digitial interventions as potential tools in prevention and recovery from the mental health consequences of adverse childhood experiences

... The burden experienced by caregivers due to BD ( Van der Voort et al., 2007) and the stigma experienced by patients (Ellison et al., 2013) may influence these expectations and attitudes of patients. It has been previously reported that BD patients were exposed to bullying, especially during childhood (Manoli et al., 2023), and their social functionality decreased (Pope et al., 2007). Traumas experienced during childhood and social withdrawal may play an influential role in shaping schemas. ...

The association between childhood bullying victimisation and childhood maltreatment with the clinical expression of bipolar disorder
  • Citing Article
  • December 2022

Journal of Psychiatric Research

... In addition to the above factors constraining our knowledge, the arts may affect emotion development differently across the lifespan, and engagement in the arts can affect the development of non-normative trajectories including autism (Alter-Muri, 2017; Lee et al., 2017), children who have experienced early life hardships (i.e., ACES; Shakoor et al., 2021), disabilities, or are resource lacking (Wexler, 2014) differently than those who are typically developing. ...

Creative arts and digital interventions: A discussion for prevention and recovery from mental health consequences of Adverse Childhood Experiences (ACEs)
  • Citing Preprint
  • February 2021