Childhood and adolescence are important developmental phases which influence health and well-being across the life span. Social relationships are fundamental to child and adolescent development; yet ...studies have been limited to children's relationships with other humans. This paper provides an evidence review for the potential associations between pet ownership and emotional; behavioural; cognitive; educational and social developmental outcomes. As the field is in the early stages; a broad set of inclusion criteria was applied. A systematic search of databases and grey literature sources found twenty-two studies meeting selection criteria. The review found evidence for an association between pet ownership and a wide range of emotional health benefits from childhood pet ownership; particularly for self-esteem and loneliness. The findings regarding childhood anxiety and depression were inconclusive. Studies also showed evidence of an association between pet ownership and educational and cognitive benefits; for example, in perspective-taking abilities and intellectual development. Evidence on behavioural development was unclear due to a lack of high quality research. Studies on pet ownership and social development provided evidence for an association with increased social competence; social networks; social interaction and social play behaviour. Overall, pet ownership and the significance of children's bonds with companion animals have been underexplored; there is a shortage of high quality and longitudinal studies in all outcomes. Prospective studies that control for a wide range of confounders are required.
Dog ownership is believed to benefit owner wellbeing but, contrary to popular belief, there is limited evidence to suggest that simply owning a dog is associated with improved mental health. This ...mixed-methods study investigates whether dog owners with stronger relationships with their dogs experience better mental health. Participants (
n
= 1,693, adult United Kingdom dog owners) completed an online survey. Owners’ health was measured using the validated PROMIS questions regarding depression, anxiety, emotional support, and companionship. The dog–owner relationship was measured using the validated MDORS scale, which has three subscales: interaction, emotional closeness, and perceived costs. Univariable and multivariable linear regression analyses were conducted, adjusting for confounding factors. Additionally, positive and negative impacts of dog ownership on mental wellbeing were coded from open questions using thematic analysis. A stronger dog–owner relationship was associated with greater feelings of emotional support and companionship but poorer mental health in terms of anxiety or depression. However, the perceived costs (burden) subscale was consistently associated with better mental health outcomes. Direction of causality cannot be inferred as people with poor mental health may acquire dogs to help relieve symptoms, which qualitative analysis supported. Key themes included positive impacts on owner wellbeing and happiness through providing purpose, companionship and self-acceptance, pleasure and distraction, as well as lessening emotional pain and suffering and reducing risk behaviors. However, negative impacts of a strong relationship include anticipatory grief over loss of the dog, and concerns regarding the burden of responsibility and ability to meet dog’s needs. Perceived ability to adequately meet dog’s needs promoted personal growth and positive relationships with others, whereas perceived inability led to feelings of guilt, or anger/frustration, and reduced autonomy and sense of environmental mastery. Dog ownership contributes to both hedonic and eudaimonic wellbeing in multiple ways, including supporting owners through periods of poor mental health and providing purpose. However, the burden of responsibility and owner and dog characteristics can create challenges, and owners may benefit from support in caring for their dogs and reducing problematic behaviors.
In developed nations, pet ownership is common within families. Both physical and psychological health benefits may result from owning a pet during childhood and adolescence. However, it is difficult ...to determine whether these benefits are due to pet ownership directly or to factors linked to both pet ownership and health. Previous research found associations between a range of socio-demographic factors and pet ownership in seven-year-old children from a UK cohort. The current study extends this research to adolescence, considering that these factors may be important to consider in future Human-Animal Interaction (HAI) research across childhood.
The Avon Longitudinal Study of Parents and Children (ALSPAC) collected pet ownership data prospectively via maternal reports from gestation up to age 10 years old and via self-report retrospectively at age 18 for ages 11 (n = 3063) to 18 years old (n = 3098) on cats, dogs, rabbits, rodents, birds, fish, tortoise/turtles and horses. The dataset also contains a wide range of potential confounders, including demographic and socio-economic variables. The ownership of all pet types peaked at age 11 (80%) and then decreased during adolescence, with the exclusion of cats which remained constant (around 30%), and dogs which increased through 11-18 years (26-37%). Logistic regression was used to build multivariable models for ownership of each pet type at age 13 years, and the factors identified in these models were compared to previously published data for 7 year-olds in the same cohort. There was some consistency with predictors reported at age 7. Generally sex, birth order, maternal age, maternal education, number of people in the household, house type, and concurrent ownership of other pets were associated with pet ownership at both 7 and 13 years (the direction of association varied according to pet type). Factors that were no longer associated with adolescent pet ownership included child ethnicity, paternal education, and parental social class.
A number of socio-demographic factors are associated with pet ownership in childhood and adolescence and they differ according to the type of pet, and age of child. These factors are potential confounders that must be considered in future HAI studies.
•Metacognitive beliefs are associated with anxiety and depression in diabetes.•Negative beliefs about the uncontrollability and danger most significant contributor.•Metacognitive beliefs explain ...anxiety and depression beyond illness perceptions.•Metacognitive model of emotional disorder has clinical utility in diabetes.
Anxiety and depression are highly prevalent in people with diabetes (PwD). The most widely used psychological model to explain anxiety and depression in PwD is the Common-Sense Model, which gives a central role to illness perceptions. The Self-Regulatory Executive Function (S-REF) model proposes metacognitive beliefs are key to understanding the development and maintenance of emotional disorders. To test the potential utility of the S-REF model in PwD, the study explored if metacognitive beliefs explained additional variance in anxiety and depression after controlling for demographic and illness perceptions.
614 adults with either Type 1 (n = 335) or Type 2 (n = 279) diabetes participated in a cross sectional online survey. All participants completed questionnaires on anxiety, depression, illness perceptions and metacognitive beliefs.
Regression analyses showed that metacognitive beliefs were associated with anxiety and depression in PwD and explained additional variance in both anxiety and depression after controlling for demographics and illness perceptions.
This is the first study to demonstrate that metacognitive beliefs are associated with anxiety and depression in PwD. The clinical implications of the study are illustrated.
Objective
Adults with Diabetes Mellitus (DM) experience high levels of depression and anxiety that are not always effectively ameliorated by current therapeutic approaches. The Self‐Regulatory ...Executive Function (S‐REF) model, which underpins metacognitive therapy (MCT), posits that depression and anxiety become persistent when stored metacognitive beliefs guide an individual to respond to common thoughts and feelings in a certain way. We hypothesized that (i) metacognitive beliefs would predict depression and anxiety independently of participants' representations of their illness; and (ii) rumination would mediate independent prediction of depression and anxiety by metacognitive beliefs.
Design
A prospective mediation study.
Methods
Four hundred and forty‐one adults with DM (Types 1 and 2) completed a two time‐point survey. Metacognitive beliefs, illness representations and rumination were measured at baseline, and depression and anxiety measured at baseline and 6‐months later. Data were analysed using structural equation modelling. Baseline illness representations, depression and anxiety were used as control variables.
Results
A structural equation analysis showed potential mediation, by baseline rumination, of any effects of baseline metacognitive variables on 6‐month distress in Type 1 and 2 diabetes samples. Significant standardized coefficients for relationships between the metacognitive latent variable and rumination were .67 (Type 1) and .75 (Type 2) and between rumination and distress of .36 and .43, respectively. These effects were independent of direct and independent effects of illness representation variables.
Conclusions
Findings are consistent with metacognitive beliefs playing a key role in depression and anxiety by increasing the likelihood of rumination in adults with DM. MCT may be an effective intervention for this population, subsequent to further longitudinal testing of the S‐REF model.
Childhood and adolescence are important developmental phases that influence health and well-being across the life span. Social relationships are fundamental to child and adolescent development, yet ...studies have been largely limited to children’s relationships with other humans. Whether pet ownership can exert similar developmental health benefits during childhood is largely unknown. The main aim of this thesis was therefore to investigate the impact of pet ownership on the development in children and young people. This thesis provides an evidence review of the current literature, and an investigation of the potential associations between pet ownership and emotional; behavioural; cognitive; educational; and language development outcomes, using the analysis of a large cohort dataset, the Avon Longitudinal Study of Parents and Children (ALSPAC). The review found that pet ownership and the significance of children’s bonds with companion animals have been underexplored within child development, and there was a shortage of high quality and longitudinal studies that controlled for confounding. This thesis aimed to address this research gap in the field using ALSPAC data, and in addition, to make an original contribution to knowledge by investigating developmental outcomes that had not yet been previously explored. Data was collected and analysed from approximately 14,000 families via parental and child reports, and clinic assessments. Analyses were adjusted for a wide range of potential confounders, including demographic and socio-economic variables, and to maximise data usage, missing data techniques were applied. Univariable and multivariable logistic and linear regression analyses were carried out to assess associations between pet ownership (any pet, dog, cat, other) and developmental outcomes. Outcomes investigated were: emotional health (self-esteem, anxiety and depression); behavioural outcomes (emotional difficulties, hyperactivity, conduct difficulties, peer problems and prosocial behaviour); cognitive development (attention, impulsivity and memory); educational attainment (KS1, KS2 and GCSE); and language development (comprehension, vocabulary, social development and non-verbal communication) in childhood. Within emotional health, evidence of an association was found between owning any pet or a cat, and a lower self-esteem (scholastic competence) at age 8. Further associations were found between any pet or other pet ownership and higher odds of social anxiety at age 7. Within behavioural development, cat ownership was associated with increased odds of hyperactivity at age 3. Owning any pet, or a cat at age 3, and owning a dog at both ages 3 and 11 was associated with increased conduct disorder. However owning dogs or other pets was associated with a lower likelihood of experiencing prosocial difficulties at age 3, and owning other pets was associated with fewer peer problems at age 11. Owning other pets at age 11 was also associated with fewer total behavioural difficulties at age 11. Within cognitive development, dog ownership was associated with poorer attentional switching at age 11. Pet ownership was consistently associated with lower educational attainment in a number of different subjects across ages, despite adjustment for logical confounders. Lastly, pet ownership was associated with a higher score in language comprehension at age 5, and a higher non-verbal communication score at age 2. This thesis finds no clear patterns across developmental outcomes, pet types or child age in the ALSPAC dataset. Pet ownership does not appear to be associated with improved emotional health, cognitive or educational development of children. Owning pets may however, have a positive impact on social development as seen through the positive associations in language development and prosocial behaviour. This thesis demonstrates the importance of using large, well-designed longitudinal studies that control for key confounders. Future research needs to incorporate age-appropriate pet attachment or pet bonding measures into future cohort studies in order to determine whether the relationships we have with our pets are of more importance than pet ownership in conferring developmental benefits.
Late-stage isolated medial knee osteoarthritis can be treated with total knee replacement (TKR) or partial knee replacement (PKR). There is high variation in treatment choice and little robust ...evidence to guide selection. The Total or Partial Knee Arthroplasty Trial (TOPKAT) therefore aims to assess the clinical effectiveness and cost-effectiveness of TKR versus PKR in patients with medial compartment osteoarthritis of the knee, and this represents an analysis of the main endpoints at 5 years.
Our multicentre, pragmatic randomised controlled trial was done at 27 UK sites. We used a combined expertise-based and equipoise-based approach, in which patients with isolated osteoarthritis of the medial compartment of the knee and who satisfied general requirements for a medial PKR were randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. The primary endpoint was the Oxford Knee Score (OKS) 5 years after randomisation in all patients assigned to groups. Health-care costs (in UK 2017 prices) and cost-effectiveness were also assessed. This trial is registered with ISRCTN (ISRCTN03013488) and ClinicalTrials.gov (NCT01352247).
Between Jan 18, 2010, and Sept 30, 2013, we assessed 962 patients for their eligibility, of whom 431 (45%) patients were excluded (121 13% patients did not meet the inclusion criteria and 310 32% patients declined to participate) and 528 (55%) patients were randomly assigned to groups. 94% of participants responded to the follow-up survey 5 years after their operation. At the 5-year follow-up, we found no difference in OKS between groups (mean difference 1·04, 95% CI −0·42 to 2·50; p=0·159). In our within-trial cost-effectiveness analysis, we found that PKR was more effective (0·240 additional quality-adjusted life-years, 95% CI 0·046 to 0·434) and less expensive (−£910, 95% CI −1503 to −317) than TKR during the 5 years of follow-up. This finding was a result of slightly better outcomes, lower costs of surgery, and lower follow-up health-care costs with PKR than TKR.
Both TKR and PKR are effective, offer similar clinical outcomes, and result in a similar incidence of re-operations and complications. Based on our clinical findings, and results regarding the lower costs and better cost-effectiveness with PKR during the 5-year study period, we suggest that PKR should be considered the first choice for patients with late-stage isolated medial compartment osteoarthritis.
National Institute for Health Research Health Technology Assessment Programme.
Women with Inflammatory Bowel Diseases (IBD) have fewer children and stay childless more often. The decision-making process around family planning choices remains incompletely understood.
We examined ...family status in women who at recruitment to the UK IBD Bioresource had not had children yet via an electronic survey. The primary outcome was the proportion of women with voluntary childlessness. Secondary outcomes were factors associated with family planning status.
Of 326 responders, 10.7% had either given birth, were currently pregnant or were currently trying to conceive; 12.6% were planning to conceive within 12 months; 54.4% were contemplating conception in the distant future (vague plans); and 22.3% were voluntarily childless. Factors associated with family planning status fell into three areas: general background (age, household income, perceived support to raise a child), relationship status (sexual orientation, being single, not cohabiting, perception of being 'in the right relationship to raise a child', perception of a good sex life) and the expression of having a child as a goal in life. On binary logistics regression analysis with voluntary childlessness versus vague family plans as the outcomes of choice, having a household income of <£30,000 (
= 0.046), not seeing a child as a life goal (
< 0.0001) and identifying as lesbian or bisexual (
= 0.047) were independent predictors of voluntary childlessness.
Clinicians should consider sexual orientation, income, younger age, current relationship and lack of expression of having a child as a life goal as important factors for family planning when providing care. Pre-pregnancy advice should be made widely available for women with IBD.
Inflammatory Bowel Disease (IBD) affects many women of childbearing age. High levels of voluntary childlessness and high levels of pregnancy-related fears have been reported amongst these patients in ...several quantitative studies. We investigated the lived experiences of pregnant patients to better understand decision-making processes around family planning.
Nine participants between 7 and 34 weeks pregnant (6 Crohn's Disease/3 Ulcerative Colitis), with an age range of 22–39 were recruited prospectively from three United Kingdom hospitals. Semi-structured interviews were conducted, and audio recorded. Interpretative phenomenological analysis was used to interpret the data.
Two main themes emerged: 1) IBD is perceived as a threat to family planning; and 2) healthcare professional advice, support, and reassurance was important. IBD was viewed as a potential threat to fertility and reproductive health. Consequently, women's lived experience of pregnancy is shaped by anxiety and pregnancy-related worries for mother and baby. Mothers actively sought out expert medical assurances to alleviate some of the perceived fears.
Previous research has repeatedly found that women with IBD exhibit high levels of pregnancy-related worries and anxieties. Our findings find that high levels of anxiety are due to patients’ perceptions that IBD is a threat to their reproductive health and their offspring. Women relied on a medicalized discourse to understand their IBD experiences during pregnancy and actively sought biomedical resources for assistance before and during pregnancy. Consultants should be aware that when dealing with pregnant patients, some women may experience anxiety and require extra support.
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