How does rumination influence the relationship between socioeconomic environment and mental health? Study Lead: Katerina Panagaki Academic Supervisors: Prof. Steven Jones Prof. Fiona Lobban Dr. Guillermo Perez Algorta This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s CLAHRC NWC Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care

Experience tells us that even under the same socioeconomic conditions only some of the people will fall in the river and develop mental health problems. What is it that triggers some and protects others? Upstream approaches like those often employed by public health focus on the wider determinants that underlie the occurrence of disease. We make policy & tackle social inequalities to prevent an event from occurring Clinical diagnoses/ illness Healthy/non clinical

Health Determinants

Coping

Rumination “responding to distress that involves repetitively and passively focusing on symptoms of distress and on the possible causes and consequences of these symptoms [but] does not lead to active problem solving” Nolen-Hoeksema, S., Wisco, B. E. & Lyubomirsky, S., 2008. Rethinking Rumination. Perspectives on psychological science, 3(5), pp. 400-424

Socioeconomic Status Mental Health Rumination Covariates: age, ethnicity, gender

Rumination Study Systematic Review Secondary Analysis Primary Analysis

Rumination Study Systematic Review Secondary Analysis Primary Analysis

What is the relationship of rumination to positive affect, auditory hallucinations and the socioeconomic status in healthy adults, adults with bipolar disorder or psychosis?

Rumination Study Systematic Review Secondary Analysis Primary Analysis

The CLAHRC NWC Household Health Survey Rumination Measures SES Measures Psychopathology Measures Rumination (brooding scale, 5 items) Economic status: Housing status Occupational Status Educational status Social capital Depression (PHQ9) Anxiety (GAD 7) Auditory hallucinatory experiences (LSHS, 2 items)

Household Health Survey – Mental Health minimal mild moderate moderately severe severe Depression 65% 18% 8% 5% 3% 72% 16% 7% 6% Anxiety No aud. Hallucinations Aud. Hallucinations 95% 4% Auditory Hallucinations

Mediation Model

Depression Housing status Direct Relationship Depression Housing status -0.146

Mediated relationship Rumination -0.08 Depression Housing status -0.07

Mediation Model

Rumination Study Systematic Review Secondary Analysis Primary Analysis

Rumination Study – Primary Data Collection Mental Health Outcomes SES Mental Health Outcomes Revised Ruminative Response Scale Response to positive affect questionnaire Mini-CERTS Economic status Occupational Status Educational status Social capital MacArthur Scale of Subjective Social Status PHQ9 Altman self-rating mania scale Launay-Slade hallucination scale

Mediation Model

Rumination Study – Mental Health minimal mild moderate moderately severe severe Depression 46% 23% 11% 9% 75% 25% Hypomania/Mania Whole sample Range 0-46 M(SD) 13.0 (11.5) Healthy subgroup Range 0-10 M(SD) 2.8 (2.9) Clinical subgroup M(SD) 17.7 (10.9) Auditory Hallucinations

Rumination Study Systematic Review Secondary Analysis Primary Analysis Cognitive experiences Behaviour

Mediation Model

Thank you  Please follow us: @Kat_Pan_ @SpectrumCentre @clahrc_nwc #RuminationStudy This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s CLAHRC NWC Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care